Permit 14 - q CITY OF TIGARD ELECTRICAL PERMIT
,. @ COMMUNITY DEVELOPMENT Permit #: ELC2013 00256
Date Issued: 05/06/2013
T 1 Gil R DI 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Parcel: 2S114AB03600
Jurisdiction: Tigard
Site address: 16515 SW 93RD AVE
Project: Dowler Subdivision: KNEELAND ESTATES Lot: 23
Project Description: (1) 200 amps or less to reground electrical panel due to plumbing changes
Contractor: ERTELL ELECTRIC LLC Owner: DOWLER, HAROLD C & GAIL K
PO BOX 279 PO BOX 230301
FOREST GROVE, OR 97116 TIGARD, OR 97281
PHONE 503 - 841 -4511 PHONE:
FAX: 503 - 359 -5652
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 05/06/2013 $100 70
Specifics: amps or less
1 ea 12% State Surcharge - 05/06/2013 $12 08
Type of Use: SF Electrical
Class of Work: ALT
- Type of Const:
Occupancy Grp:
Total $112 78
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 OAR 52- 001 -0090 Yo may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344 I r
Issued By: K.aJ Permittee Signature: O1 •� 7o PPLl !4 WW1
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.
May 03 13 11:06a Ertell Electric, LLC 5033595652 p.1
Electrical Permi A • ! lication DECEIVED FOR OFFICE use ONLY
City of Ti t and I Receive/BY: 5-1 Q3 ST Permit No : e% do i 3- J0,9.5<0
!I • n 13125 SW Hall Blvd., T gard. OR 97223 MAY 0 6 2013 Plan Review
Phone: 503.71:2439 ax: 503.598.196 . ,T Date/By Other Permit.
TI G A F D Inspection Line 503.63" CITY OF TIGARD
Date ReadylBy ]uric RI See Page 2 for
Internet www. igard !coy BUILDING D , Notified/Method: I I 'S' Supplemental Information
` 11 , . ,- C ' .k. -6, C ------ 4 46 4F:= I - - -: Y_5 - _ . .
❑ New construction ® e ditionralteration /feplacement Please check all that apply (submit 2 sets of plans w /items checked below)
ID Demolition ❑ • her: II ❑ §ervice or feeder 400 amps or more ❑ Building over three stories. I 11vhere the available fault current ❑ Marinas and boatyards
"- 4 '' - �* t ; r A cTLot' (
... ' . = - .... . .:`:�:; :x - '1: - :':' - 'i':;: - .1!""14'; - ;',. - exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
- less to our or exceeds 14,000
dwellin L Br d ❑Commercial -use agricultural
® 1- and 2-family ❑ C•mmercial /indus al ❑Accessory building amps for all other installations. buildings
[3 Multi-family 1:1 aster builder 1 ❑ Other. ❑ Fire pump. ❑ Installation of 75 KVA or
- - • " JO
- B D: rI ' 4 3 ' - El Emergency system. larger separately derived system.
- - ... - „: + ':� " ❑ dditiim of new motor toad of
00HP or mare, occupancy.
❑ `•A ", "E" "1- 2 ", "1 -3 ",
Job no.: J . b site • • dress: I l 51 S ` 11) 7 rd Auer, I In� ue. - t) P . ❑ ix or mote residential units. ❑ Recreational vehicle parks.
City / State/ZIP: O. q ❑ ealth -care facilities. ❑ Suppl voltage for more than
- / / J •
❑ azatdous locations. 600 volts nominal.
Suitefbidg laps no.: •ject name: ,{1 1:1 Service or feeder 600 amps or more.
it — Um 1
k.
`'t : _•. .' ., ; :' • LE'.
Cross street to jo. site: nesertpiion r c.,,,;. Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,010 sq, ft. or less 1 168.54 1
Ea.ladd'I 500 sq ft. or portion 3392 ' 1
Tax map/parcel :
no. tial
- - - ... -• -. 7800 2
- t al'l''CION --o �l& t • ` . -_ ... - - Lir� bovesq ft) '
i= - : i LiMited energy, multi-family
75.00 2
I { esidential (with above sq. ft.)
I Re(iewabk End ❑ See Paget
MBAR= Services or feeders installation, alteration, and /or relocation
a PRO = ' - a ` - • - . : • F ❑ :'CrPPANI;: " y i, 4 ; ' • 200 amps or less k 100.70 00, 2
2011 amps to 40D amps I33.56 2
Name:
4011 amps to 600 amps 200.34 2
Address: I 601j amps to 1,000 amps 301.04 2
Over 1.000 amps or volts 552.26 ^
_
City /State/ZIP: Temporary services or feeders installation, alteration, and /or
Phone: ( ) I F ; ( ) retocation
201 amps or less 5936 1
Owner installation: This i - allatio is being m on property that I own which is not 2011 amps to 400 turps 125.08 2
intended for sale, lease, rent or exc .: ge, accordi g td ORS 447, 449, 670, and 701.
Owner signature: I Date: t
4411 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
` . _ -- 0, 4014 _ _ -_- � � A. fee for branch circuits with
• ` - Ci13IAGl.]¢1N - above service or feeder fee.
Business name: each branch circuit 7 43 2
B Tee for branch circuits without
Contact name: service or feeder fee, first 56 18
branch circuit
Address: i Each add !branch circuit 7 42 _
City/State /ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84
I
Phone: ( ) F. :: (. ) dwelling• service and/or feeder =
Re only 67.84
E -mail: i Pur,p or irrigation circle 67.84 2
. . - -: -' ....- ' ' f _o I '? O'' :.1 -, - Sigh or outline lighting 67.84 2
Business name: 4 I Si al circutt(s) or limited-energy
ti � , k ' - _Asa — pan 1, alteration, or extension Page 2 2
Address , CD . • �k Z c Lath additional inspection over allowable in any of the above
�` Additional mspcction (1 hr min) 66.25/ hr
City /State /ZIP: i exe....A._ err • ' cry/ Investigation (1 hr min) 66 25/hr
F
Phone: Industrial plant (1 hr min) 78.18/ hr
(11ivQ} _ . 5 ( rJQ� ) ? - rJ�orJ2
.��Lr Inspections for which no fee is 90.00 / hr
CCB Lic.: I 0 Elect al Lic.: �' - • I Su r Ic.: S spel:ifically listed (A hr min)
Su n'. Electrician signature require i r I ET GTI.I0VP.ABMiti• S= -' -,.. .. -
��s • i,t ^�.:�
P r� � , �, � �• Subtotal. (CC), - 70
MIME ��JLL � Date 3,�, 1 I Plan review (25%ofpermitfee):
� L� I State surcharge (12%ofpermit fee) li t -QU
Authorized sign at re: 11 1.11 �j I TOTAL PERMIT FEE: ,4-- 1- +j7400
Print name: Date: This permit application expires if a permit is not obtained within 180
� - ,� !UGC.
rj ,�..� All 1 az days after it has been accepted as complete
• umber o inspections allowed per pmt
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