Permit CITY OF TIGARD ELECTRICAL PERMIT
'1 3 • COMMUNITY DEVELOPMENT Permit #: ELC2013 -00324
T [ GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/12/2013
Parcel: 1 S135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 570
Project: Houser & Allison Subdivision: ASHBROOK FARM Lot: PTS 5 &
Project Description: Electrical for TI.
Contractor: DYNALECTRIC Owner: SUN LIFE ASSURANCE CO OF CANADA
5711 SW HOOD AVE BY NORRIS BEGGS & SIMPSON
PORTLAND, OR 97239 121 SW MORRISON ST #200
PORTLAND, OR 97204
PHONE: 503 - 226 -6771 PHONE:
FAX: 503 - 226 -7720
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 06/12/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/12/2013 $7.63
Type of Use: COM 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 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 952 - 001 -0090. You may obtain = •' ' • _ ules or •uestions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: I . - / - Permittee Signature: : �'� 7o ` = /_ — �4•ii
OWNER INSTALLATION ONLY
i
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 503.839.4175 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.
Jun. 4. 2013 12:58PM No. 1367 P. 2
i Electrical Permit ApplicatiRECEIVED FOR Orr(Cl. USE ONLY
City of Tigard JUN 0 4 2013 Received Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
1 11 o Phone: 503.718.2439 Fax: 503. ►> ieroFTIGARD Date/13y: Other Permit:
TIGARD Inspection Line; 503.639.4175 ..ii V Date Ready/By: Jura; fa SeePa(e
Interact: www.ogard- or,gov BUILDING DIVISION Notified/Method: -- 1(y Supplemental Information
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: ,: :r.PE'OT' \1'.O7t.IC,'
• •, ... ' � PtirCIV REVI6y :'
❑ New construction LB Addition /alteration /replacement Please check all that apply (submit seta of plans w /items checked below);
0 Service or feeder 400 amps or more ❑ Building over three stories.
�] Demolition ❑ Other.
where the available fault current ❑ Marinas and boatyards.
"CATEGORY.: or - I nuCTION • exceeds 10,000 amps of 150 volts or ❑ Flooring buildings.
0 less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
I- and 2- family dwelling Il Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder El Other: ❑ Fire pump. ❑ Installation of 75 KVA or
: / ❑ Emergency system. larger separately derived system.
:7', JOI). SITE •II�FORMA uON AN4,LOCAI -ION ❑Addition of new motor load of ❑ "A "C° "1.2"
Job no, ���907 Ig Job site address: �� � Imorn. occupancy,
❑Six or or more residential units. ❑ Recreational vehicle
parks.
City /State /ZIP; ,-� A,- 'A lJ Hcalra•care facilities. ❑ Hazardous locations. ❑Supply voltage for more than
�/ 600 volts nominal.
Suite/bldg./aril, no: 570 Project name ;. ❑ Service or feeder 600 snips or more.
TeEE'.SCII :., t.' ' ,
Cross street/directions to job site: Au5�e SL A L L / 5 ,. � neseriaron I Qty. I Pee. I ' To ta l I • 1
New residential single- or multi- fnmlly dwelling unit,
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.:
Ea. add'I 500 sq. ft. or portion 33,92 1
Limited energy, residential •
.:'1:''..:.•'...:•: .. Dk:SClti['T [ON.:Olif 75.00 2
, , , t (with above sq. ll.)
27 _ Limited energy, multi - family 75.00 2
� �' C jr residential (with above sq. fl.) i 225 Renewable Ener fty CI See Page 2
Services or feeders Irlatnilationolter9 (ion, and /or relocation
200 am S or Tess
,: ❑ ji.ROEERTY OWNER . ❑ 'f[sNA P 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address; 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552,26 2
City /State /ZIP: Tclnpornly services or feeders installation, alteration, and /or
Phone: ( ) I FAX; ( ) relocation
200 amps or less '59.36 l
Owner installation; This installation is being made on property that 1 own which is not 7 201 amps to400amps . 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
Owner Signature: Date: Branch circuits — new, alteration, or extension, per panel
.:; ,,- . :'`.'•; °' APPLICAN'P • `, :':; •' .•.,I: X CONTr►CT PERSON ' A. Fec for brooch circuits with
above service or feeder fee,
Business name: �yAeZ i _ M — each branch circuit
13 7.42 2
. Fee for branch circuits Irlrnotrt
Contact name: —5CDh `i ) service or feeder fee. Viral / 56.t S _4,/$ 2
branch circuit
Address: Each add'I branch circuit 1 7,42 Z, Lf�' 2
City /Stale /ZIP: Miscellaneous (service or feeder not included)
Each manufactured or 'nodular
Phone:) R , / 77 / I Fax :: ( ) dwelling. service and/or feeder 67,8a 2
CC Reconnect Only 6784 2 '
E Pump or irrigation circle 67.84 2
CONTRA TOR; Sign or outline lighting 67.84 2
Business name: I f , Signal circuit(s) Or limited -energy
1 a panel, alteration, or extension. Page 2 2
Address: J I �� 4 d Each additional Illspectlon over allowable in any of the above
�� Additional inspection (l hr m hr min) 66.25/ hr
Ciiy /Stale /ZIP: Invesopion hr min) 66.25/hr
Phone: (.)3) tp Re . 77, `"'++ °`OAP vK� F ax: ( ) "'�/_, 7 f1 Industrial plain (I hr min) 78.18/hr
Inspections for which no fee is
CCD Lie.: /z74, 7? , =triad Lic. /0 : S � tprv, Lic.: Li 6 $ c , spccil lustcsJ S hr min) 90.OD/ hr
,. ■' . ELECTRICAL.; PERMIT FEES:
Suprv. Electrician signature, required: �i . Subtotal: f�
Print name; �t r4Q `\ f �� D. te. h41d3 Plan review (25% of permit fee): r
Slate surcharge (12% of permit fee): 7, to
Authorized signal - - t
fir - J TOTAL PERMIT FCE
— This permit application expires If a permit Is not obtained (,;thin I
Print name:
i . .,,,. - AMDate: � Ar,/ Jays after It has been accepted ns complete.
' Number of inspections allowed per permit.
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