Permit a CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2013 00331
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/13/2013
Parcel: 2S104AC11200
Jurisdiction: Tigard
Site address: 12760 SW 134TH AVE
Project: HERZBERG Subdivision: DEER POINTE Lot: 3
Project Description: (1) branch circuit to rewire lights.
Contractor: SQUIRES ELECTRIC Owner: HERZBERG, SHAWN C & ANNE
1001 SE DIVISION STREET #1 12760 SW 134TH AVE
PORTLAND, OR 97202 TIGARD, OR 97223
PHONE: 503 - 252 -1609 PHONE:
FAX: 503 - 253 -5831
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 06/13/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/13/2013 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 a copy of -s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued By: Permittee Signature: ,G,f / �_.�
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 603.639.4175 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.
Electricai Per A lication :..
1�1 D . - `: ``` Folt. ur.Flrc us> :OL :. : '::; -- - _:_ �: '''.
City of Tigard Reeeived
° g JU 1 3 2 13 Datea •: / ,11 Permit NO.; _ N � ^1;� _ W331
13125 SW Hell Blvd., Tigard, O R 97223 Plan Review
t !"`�
Phone: 503.718.2439 Fax: 503.598.1960 I Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 CITYOFTIGARD I Date ReadyiBy: furls Id See Page 3 for
Interne: wvhw.tigard or.gov �tni n1NCDWISIO kottfied/Mctllod: !mot/ Supplemental Information
"•' TYPE or WORK PLAN REVIEW
El New constru 1 .:0 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 El Other:
where the available fault current ❑ Marinas and boatyards.
r _ I - and 2 - family dwelling CATEGORY OP CONSTRUCTION exceeds 10.000 amps at ISO volts or ❑ Floating buildings.
t less to ground or exceeds 14.000 ❑ Camn,ercial - use agricultural
g ❑ Commercial /industrial ❑ Accessory building amps for all other installations.
P buildi „ge. I
❑ Multi - family ❑ Master builder
❑ Other: ❑ Fire pump. ❑ Installation of 73 KVA or
3018 SITE INFORMATION AND LOCATION ❑Emergency system. larger Separately &rivt d % s1v,n
0 Addition of new motor load o r ❑ °A” "E" "I -�° °1 -1°
Job no.: Job site address: `2? .. S� _ 4 N 100HP ormore. occupancy.
�� a 0 Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: ,, • . I a' P'■-.B ❑ Health -care facilities.
0 Supply voltage for more than
Suite/bld / L n0 :: ❑ Hazardous locatio c.. 600 volts nominal.
g• Project name: es, Z bee-J ❑ Service or feeder 600 amps a• more,
Cross street/directions to job site: FEE SCHEDULE
nneriplion I Qty. I Fee. I rood T
New residential single- or multi - family dwelling unit. .
Includes attached garage.
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Subdivision: I Lot no.: 1,000 sq. 0. or less 168.54 4
Tax map /parcel no.: Ea. edd'l 500 sq. R. or portion 33.92 1
• Limited energy. residential 75.00
DESCRIPTION OF WORK (with above sq. ft.)
1. 1 ' ■ Limited energy ulti
moo-family
�{ _ 1 l �� residential (with above sq. (1.1 75.00 2
Renewable Energy I ❑ See Page 2
Services or feeders installation alteration, and /or relocation
❑ PROPERTY OWNER ❑ TENANT _ 200 amps or less 1 l 100.70 f
Nme: 201 amps to 400 amps { I t 33.56 f i 4
401 amps to 600 amps 200.34 " 2 !
4 dress: --
601 amps to 1.000 amps 301.04
`arty /State/ZIP: Over 1,000 amps or volts 552,26 2
Temporary services or feeders installation, alteration, and /or
Phone: ( ) F ax: ( ) relocation
Owner installation: This installation is being made on roe 1 200 amps or less 59.36 I I 1
intended for sale, lease, rent, or exchange, according to ORS 447 449, 670, and 701. 301 amps to 400 amps I25.OS 2
M 401 amps to 599 amps 168 54 l 2
Owner signature: Date: I
Branch circuits — new, alteration. or extension. pier panel
❑ CONTACT PERSON A. Fee tar branch circuits u'hh
above service or I•eeder fee.
Business name: SQUIRES ELECTRIC, INC. each branch circuit
7.42 I I
Contact name: ANDREW COHEN B. Fee for branch circuits wrr /,wri
service or feeder f8e (test
I 36 18 1$ 1
Address: 1001 SE DIVISION ST -, #I branch circuit Q r
Each add'! branch circuit 7.42 12
City /State/ZIP: PORTLAND, OR 97202 Miscellaneous (service or feeder not included)
Each manufactured or modular
67 .84 2
Phone: (503) 252 - 1609 Feu: :: (503 -) 253-5831 dwellins, service and /or feeder
E ANDREWQa SQUIRESELECTRIC,COM Reconnect only 67.84 2
Pump or irrigation circle 67.84 1 2
CONTRACTOR _ Sign or outline lighting 67.84
Business name: SQUIRES ELECTRIC, INC. Signal circt or limited- energy' —
Address: 1001 SE DIVISION ST. #1 panel, alteration, or extension. ` Page 2 2
Each additional inspection over allowable in any of the above
Additional inspection (I hr min) 66.25/ hr
City/State/ZIP: PORTLAND, OR 97202 l I
Investigation Cl hr min) _ 66.25/ hr
Phone: (503) 252 -1609 Fax! (503) 253- 1 I itstrial plant (1 hr min) 78.18/ hr `
C I
GCB Lic ; 13508 r!CC r feel Inspections for which no fee is I 90.00 / hr
6 1 101 C Supra. Lie.: 4882S _spa, ifttally listed (% hr min) I I j
Suprv. Electrician signature, r 4 - e —,_,, ELECTRICAL PERMIT TEES
) d f Subtotal: '" 1114 1
t name: JOE SQUIRES I _ i Date; ( r 1 1 13 Platl review (25% of permit f'ee):
Authorized signare: 1 M State surcharge (12%of petmmit fee); (p , 4
--- TOTAL PERMIT FEE: � ^1 I
Print name: JOE SQUIRES / ' Date: This permit application expires if a permit is not obtained within 180
r / I days after it has been accepted as complete.
t'tBvildingnPUrmirttict,C Pem • Number of inspections allowed per permit.
445 _ 41 Sliti /O3.'COm wE6
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