Permit � n CITY OF TIGARD ELECTRICAL PERMIT
: '- a '`- COMMUNITY DEVELOPMENT Permit #: ELC2013 00164
T jGARD? 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/13/2013
Parcel: 25111 BCO3200
Jurisdiction: Tigard
• Site address: 10335 SW VIEW TER
Project: Luke -Dorf Subdivision: DOUGLAS HEIGHTS Lot: 9
Project Description: (2) branch circuits to reconnect furnace and heat pump.
Contractor: JM3 ELECTRICAL & CONSTRUCTION LLC Owner: LUKE -DORF, INC
10500 SW CLYDESDALE TERR 10313 SW 69TH AVE
BEAVERTON, OR 97008 TIGARD, OR 97223
PHONE: 503 - 961 -3537 PHONE:
FAX: 503 - 718 -7268
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 03/13/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/13/2013 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in a • : - - • ' • approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more, the 180
days. ATT •• ION: Oregon , w r-' 'ire _ you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth ' in OAR
952 -001 -0 • 0 thro gh OAR 952-01 '090. o . y obtain a copy of the rules or direct questions to OUNC by calling 51 r. 32.1987 or 1.800.33. 234' 4
Issued I / �� r <l_ Pe rmittee Signature: u CJ ') ■ ��� '
y: LLB g I I /. .
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
-----` CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' ► Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept In a conspicuous place on the Job site until completion of the project
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE ESE ONLY •
City of Tigard Deceiv di
13 / I Permit No.: e�L' b/3-49.0/6Y/
13125 SW Hall Blvd., Tigard R EIV Plan Review
0 ' Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit: / t'l 5- 00/4/0
T G A R D Inspection Line: 503.639.4175. MAR 1 3 2013 Date Ready /By: kris' ® See Page 2 for
Internet: www.tigard- or.gov fin , Notified/Method: Supplemental Information
' t M PLAN REVIEW
❑ New construction 0 Add / : lt9laWDENISION1t Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
7 1 I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "l -3 ",
Job no.: Job site address: 03 3$ S. ( 0��/ r f' : 100141 or more. occupancy.
City/State/ZIP / L9�/ ��� �� ❑ H ealth-care facilities.
x or more residential units. ❑ Supply voltage vehicle
f r more ore
Cit than
y r ❑ H ❑ Supplltaor th
CI Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description
I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 ' 4
' Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
(with above 11.) 75.00 2
AESCRI ION OF WOIII K ( sq.
,1 /# C IP l ' Limited energy, multi-family 75.00 2
/ GC. eCe) /9A & / v`n �� G /r C(�/' residential above (with above e sq. q. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 t 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, ,�' 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without ...0-•
service or feeder fee, first
/ - ,.- 5 2
Contact name: branch circuit
Each add'I branch circuit / 7.42 ?.4 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State /ZIP: dwelling, service and/or feeder
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: 7l / 3 Eire /v/ G eii5, re,(.4,/7 panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: /l -g0 SG(., C/ of , a P T �-yle Additional inspection (1 hr mm) 66.25/ hr
p Investigation (I hr min) 66.25/ hr
City /State /ZIP: �PWVer� � ��� � OC� g Industrial plant (I hr min) ) 78.18/ hr
Phone: (5 ?J) W._35 Fax: (03)7/g._ 7 7268 Inspections for which no fee is
specifically listed ('A hr min) 90.00 / hr
CCB:Lic.: /928,)6 1 Electrical Lic.: e b7. 2 / Suprv. Lic.: 5
7 9215 ELECTRICAL PERMIT FEES
Subtotal: 0.4t
�`�l Suprv. Electrician signature, required: ej Plan review (25% of permit fee):
Print name: c/ ve7,(7 7- C � 33A
Date: 3A3 State surcharge (12% of permit fee): 7r
TOTAL PERMIT FEE: 71---5 7"
Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete. 7/.25
Print name: Date: • Number of inspections allowed per permit.
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