Permit CITY OF TIGARD ELECTRICAL PERMIT
S COMMUNITY DEVELOPMENT Permit #: ELC2013 -00250
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/01/2013
Parcel: 25111 BA00805
Jurisdiction: Tigard
Site address: 14130 SW 100TH AVE
Project: Randall Subdivision: TIGARDVILLE HEIGHTS Lot: 25
Project Description: (3) branch circuits for eco tran control box and alarm bell
Contractor: FIVE STAR ELECTRIC, INC. Owner: RANDALL, MARIA L
756 SW BAILEY AVE 14130 SW 100TH AVE
HILLSBORO, OR 97123 TIGARD, OR 97224
PHONE: 503 - 324 -0948 PHONE:
FAX: 503 - 324 -0973
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 05/01/2013 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/01/2013 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 accordance with 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OA 2 -001 - 00 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232..1 4-Pie/// 987 or 1.800.332.2344. �J
Issued By: L .fit p J Permittee Signature: old Cry 7U
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.
From:5 Star Electric 503 324 0973 04/30/2013 14:45 #168 P.002/003
Electrical Permit Application RECEIVE, I'OR 01. 11( I. SE ONLN
City of Tigard >^i PR 3 0 2013
' Permit No : LLC .Ao( ; 0
1,
• 13125 SW Hall Blvd., Tigard, OR 97223 plan Review
Phone: 503.718.2439 Fax: 503 pate's .
Other Permit:
t RI)
lnspection Line: 503.639.4175 CITY OF TIGARD Date R /By: tuns ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISin LTNotified Method: !v Supplemental Information
TYPE OF WORK PLAN REVIEW .. '
❑ New construction Addition/alteration /replacement 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.
1- and 2 - family dwelling ❑ Commercial /industrial ❑ Accessory building less to ground, or exceeds 14,000 ❑ Commercial-use agricultural 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", "1 -2" "1-3",
} I rc5 (�(J ` ^ a `' /) . I00HP or mote. occupancy.
Job no.: 5 1, �° Job site address: i� ( S i 1'fC
n (� J �`+a' -1 / ' 0 Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: " �.- ff . J {/ � -/ 7, , ❑ Health -care facilities. ❑ Supply voltage for more than
l ` / ✓1 JX ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 2 r� p ?U il, jD ❑ Service or feeder 600 stops or more.
Cross street /directions to job site: ``''�� t ! Description FEE SCHEy I
) Q7'. 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' 1 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. fl..) 75.00 2
Li
(I ) cj' , ( � � , c Limited eneru, multi- family
it y-et� �0 b h resi dential (with above sq. ft.) 75.00 2
(. C' Services or feeders installation, alteration, and/or relocation
/) t G/ C fe_7f Cd% vi'1't,,(2�LC 200 amps or less 100.70 2
❑ PROPERTY 0 1 ❑ TENANT 201 amps to 400 amps 133.56 2
Name:
401 amps to 600 amps 200.34 2
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
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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 1 ❑ CONTACT PERSON above service or feeder fce. 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
. service or feeder fee, first f 56.18 r I If 2
Contact name: branch circuit
Each add'I branch circuit 2, 7.42 ) y . & 1 1 - 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Five Star Electric, inc.
panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 756 SW Bailey Ave Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/ State/ZIP: Hillsboro, OR 97123 Industrial plant (I hr min) 78.18/ hr
Phone: (503) 324 -0948 Fax: (503) 324 - 0973 Inspections for which no fee is 90.00 / hr
specifically listed W. hr min)
CCB Lie.: 158231 Electrical Lic.: 665C Suprv. Li 455 . -
ELECTRICAL PERMIT FEES " r
Subtotal:
Suprv. Electrician signature, required: -7/ - / 77,
Plan review (25% of permit fee):
Print name: Cam, i G fJ y d- Date: �'- 3 G - ) State surcharge (12% of permit fee): $ , 2_
l.[" TOTAL PERMIT FEE: G3 Li
Authorized signature: ThIS perms[ application expires if ■ permit b not obtained wit 1
days after it has been accepted as complete.
Print name: Date:
Number of inspections allowed per permit.
-
I. ELC- PermaApp.doc 57./01110 440.4615T(11 /OS'COMWEB
From:5 Star Electric 503 324 0973 04/30/2013 14:45 #168 P.001 /003
RYE STAR ELECTRIC
COMMERCIAL/INDUSTRIAL/RESIDENTIAL
FACSIMILE TRANSMITTAL SHEET
TO:
FROM:
Community Development Becca Sinner
COMPANY: DATE:
City of Tigard 4/30/13
FAX NUMBER TOTAL. NO. OF PAGES INCLUDING COVER:
503 - 598 -1960 3
PHONE NUMBER: SENDER'S REFERENCE NUMBER:
RE: YOUR REFERENCE NUMBER:
Permit Application
Thanks,
j/ i
Becca Sinner
Administrative Assistant
Five Star Electric, Inc.
Phone: 503- 324 -0948
Fax: 503-324-0973
bsinner @fivestarelectric.org
756 SW Bailey Ave., Hillsboro, OR 97123 * Phone: (503) 324 -0948, Fax (503) 324 -0973 * CCB# 158231
LICENSED • BONDED • INSURED
•