Permit n CITY OF TIGARD ELECTRICAL PERMIT
I I I $ COMMUNITY DEVELOPMENT Permit #: ELC2013 -00358
Date Issued: 06/27/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 2S109ACO5400
Jurisdiction: Tigard
Site address: 13231 SW NICOLE LN
Project: Bellenghi Subdivision: WILSON RIDGE NO 2 Lot: 22
Project Description: Reconnect only
Contractor: OWNER Owner BELLENGHI, ROBERT H
BELLENGHI, ROB & TAMI 13231 SW NICOLE LANE
7174 SW 161ST PL TIGARD, OR 97224
BEAVERTON, OR 97007
PHONE:
PHONE: 971 -409 -8571
FAX.
FEES
Quantity Description Date Amount
1 ea Reconnect Only 06/27/2013 $67.84
Specifics:
1 ea 12% State Surcharge - 06/27/2013 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 -0.09 You may obtain a copy of the rules or direct questions to OUNC by calling 503 232.1987 or 1.800.332.2344
j
Issued By: /C (if ' ' ' Permittee Signature: d/V �/e/ 34 / (#4
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.
CHAPEL STEEL Fax:503-228-3002 Jun 26 2013 01:26am P002/002
.
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. . City of Tigard
1 14 ..1 13125 SW Hall Blvd„ Tigard, OR 2 Plan Review
' •
- ,`• ' Phone: 503,718.2439 Fax: 503,598.191(m 2 6 2013 mo Other Permit
T I GARD b .
Ins Line, 503,639.4175 Date Ready/By; ' .1u „. _ rel Sec ['age 2 fur
• Intemet, www.tigaid-on ' TIGAD gov Nolified/Metlio& . / ,/(1 &mph:menial Information
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„,,: !• ,,;.;,---,, - ;. • •••• .,,,!,, .,..:-,,,....tvrp,or QF
,.- . ,,• • , . J- i • ' -- -, .‘ . .‘,‘...,..,''(' •;- ,,:,,•-, , PLAN REV111',W, `,,, .• Ll.r
0 Now construction 0 Addition/al ., •
. .t. I , V. r ' ''' Please cheek all that apply (submit 2 sets of plans w/ilents checked below):
placement
0 Service or feeder Ann
amps or more 0 Building coma °nee stories
0 Demolition El Other: Electric Reconn where the available Fuuli orient 0 Kirinas and boatyads.
'' • ''• - • • '','''-''''' ' '''' •-•' '' ' CATF GORY . OF CONSrt RUCTION :: , , ril ' i' '. ” - , - ' - ' . exceeds 10000 amps at 150 volts or 0 Floating buildings
late to ground. oi exeeeds 14,000 0 Conitneicinl-use ugaiciittural
g 1- and 2-family dwelling 0 Commercial/industrial El Accessory building amps for all other install:Ilion buildings,
Li Multi-family 0 Master builder 1=1 Other: 0 Fun pump, 0 Installation ,,r 150 KVA oi
, . ,. „ . , , . .. , , , .. ' ['Emergency lystem. larger sepal ally derived system,
,•'''' ',1 '" Si ,.. iN' eoarvIntION L 'Ai9..,,A,OCATION ..;:'.., ",': ' ' '''' ,'
:,,,,. , - . . , ;; 12 Addition of new motoi load of 0 "A" "E", "1-2" "1-3",
i 001 or morc occupancy
Job no,: lob silo address: 13231 SW Nicole Ln
Psis or more'rcsidenual units, 0 Reineational vehicle pinks,
-
City/Statc/ZIP: Tigard, OR 97224 0 Health-ore' facilities. 0 Supply voltage for more 111,111
....„ El Hazardous loculions, 600 volts nominal
Suite/bldg/apt. no.. Project name: Bellenghi 0 service oi feeder 600 amps ot more.
I ':II'•,: •'"„'" . ' It'LE'. SCREDUI.E'.":',,
Cross street/directions lo job site: SW 133rd Descri Ilrut WYE Fee. TOIal •
New residential single- or multi-ritually dwelling unit.
includes attached garage.
SubdiViS1011: Wilson Ridge Lot no.: 22 1.000 sq, ft or ins 168,54 4
En add'I 500sq, ft, or portion 33 92 I
Tax map/parcel no.: R2152661 Limited energ, residential •
75,00 2
rili ' OF WORK I ‘..'' ' ',',•'.."' .f.■"' (with above sq. It)
Limited energy, multi-fanuly 75 00 2
Electrical Reconnect residential (with above sq. IL)
Renewable Energy I 0 Sec Page 2
...
Services or feeders installation, alteralion, aiidfor relocation
E',..pitopti.9;*."61Elt !, ':,L'. i,: .' ,',:-,.., ,LE] - 1 - TENTN'X;;' . ::.,',; ..'.;,I1:1„11, 200 am ' I's 100 70 2
— 201 amps to 400 amps 133.56 2
Name: Rob & Tami Bellenghi 401 amps to 600 snips 200,34 2
Address: 7174 SW 161" P1 G ,-- e-hii:.- -- - - p H - 6 IN) 601 amps to 1,000 nrno 301 04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: 97007 Temporary services or feeders 'ustallation, alteration, and/or
— --
Phone: (971)409-8571 Fax' ( ) relocation
200 amps or less 59.36 I
Owner installation; This installation is being made on property that 1 own which is not 201 amps to 400 umpS 125,08 2
intended for sale, lease • n , r e 'h ge, according to ORS 447, 449, 670, and 701. — —
401 amps to 599 amps 168.54 2
Owner signature; 1Date: Crj ZS Branch circuits - new, alteration. or extension, per panel --
.....
:,:.5'. J;: . ''llill APPIXO'A NT, ':.: ... :; ' Era ilt8 ''': - ''. A lee for branch circuits with
above service or feeder fee,
7,42 2
Business name. M Realty each branch circuit
— B. Fee for branch circuits without
Contact name. Bryan Durk service Or IC.Cder fee, first 56 18 2
brunch circuit
Address: 2211 NW Front Ave Each u branch ci rcui t 7 42 2
-- _
Misceilaneons (service or Iceder not inclu(led)
City/State/ZIP: Portland, OR 97210 Bach munuf,tctured or modular
67 84 2
se
Phone: (503) 913 Fax. - . (815) 550 dwelling, service and/or feedr —
Reconnect only 1 67 84 67.84 2
E lb ryrin lcd@niac.co m Pump or irrigation circle 67,84 2
s •''''"1 . : '• ,''''';'." ",'''I ' H H ".,;:',CONTRACTOR ';''1';'4. : .• 777.:!;.',.: ,,.',..., .,,, ' Sign or outline lighting 67,84
Business name: NA Signal circuit(s) or Wiled-energy See
_ — panel, alteration, or extension. p a g e 2 2
Address: Each additional Inspection river allowable in any of the above
Additional inspeution (I hr min) 66,25/ hr
City/State/ZIP: investigution (1 hr nun) 66 25/ hr
---, - . -
Phone; ( ) Fax. ( ) Industrial plant (1 hr min) 78.18/ hr
Inspections for which no foe is
CCB Lie.: Electrical Lie,: Suprv. Lie.: specifically listed (S hr nun) 90,00/ hr
_ , -.,'',i'•:,:',:i - :',,ELECFRICAL TBRMIP' '; - .. :., . "',,
Suprv. Electrician signature, required: Subtotal' 67.84
Print name: Date. Plan review (25% of permit fee): 0
State surcharge (12% or permit fee)' 8.14 .....,..„.--
Authorized signature: . . TOTAL PERMIT PEE' 75.98
; rids permit application expires if u permit is not obtained within 180
Print name: Date: . dap. after It has been .111:cepluil M epiiiplete.
Number of inspections allowed pct permit.
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