Permit u CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00351
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/26/2013
Parcel: 2S110BA07300
Jurisdiction: Tigard
Site address: 12155 SW WILDWOOD ST
Project: Rath Subdivision: SHADOW HILLS NO.2 Lot: 58
Project Description: (1) 200 amp service and (2) branch circuits
Contractor: PDX ELECTRIC LLC Owner: RATH, ROBERT
7933 WHITFURROWS CT 12155 SW WILDWOOD ST
DURHAM, OR 97224 PORTLAND, OR 97224
PHONE. 503 - 997 -1989 PHONE:
FAX: 503 - 200 -1362
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 06/26/2013 $100 70
Spec ifics: amps or less
2 crt Branch Circuits w /Purchase 06/26/2013 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 06/26/2013 $13 86
Electrical
Type of Const:
Occupancy Grp:
Total $129.40
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 ordanc. ith 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 ENTION Orego la - quires you to follow the rules adopted by the Oregon Utility • • y ion Center Those rules are set forth in OAR
952 -0 -0010 through OAR 95 ' X01 -0r9 You may obtain a copy of the rules or direct questions to OUNC • 987 or 1 800 33 344
i
Issu By: k ` / Permittee Sign ar
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 data.
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.
6/25/2013 4:03 PM From: PDX Electric LLC / 503 - 200 -1362 To: 15035981960 2 of 3
Electrical Permit Application ED F nl F I .�r c►,1.� _.
v City of Tigard Received J Mgr
1 V % ♦ Permit No�L
13125 SW I lall Blvd , Tigard, OR 97223 U N 2 5 2013 ran Rcvie L �L3___._ r _- ..____. - _ ..__ _- __..._ ?Pl_3 .. - ! >I �, ��
® Phone 503 718.2439 Fax' 503 598 1 _ 3ate/B Other Permit'
TI . A 1 ,t -) Inspection Line' 503 639 4175 f)ateReady /By 11011.119111 III See Page 2 for
Internet www- tigard -or gov CITY OFTIGARD Notified /Method Supplemental Information
TYPE OF _� -_
�� I�VliIP IS ION . . -... ^ - - -- PLAN REVIEW
❑ New construction E Addition /alteration /replacement Please check all that apply (submit / sets of plans whims checked below)
❑ Service or feeder 400 amps or inure ❑ Building over three stones
❑ Demolition ❑ Other: where the available fault current ❑ Mannas and boatyards
CATEGORY OF CONSTRUCTION exceeds 1 0,000 amps at 150 volts or ❑ Floating buildings
less to ground, of exceeds 14 ,000 ❑ Commercial -use agricultural
® I- arid 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations buildings
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system
❑ Addition of new morn load of ❑ "A ', "H' , "I -2', "I -3 ",
,lob no.: Job site address: 12155 SW Wildwood St 1001 -1P or mure occupancy
❑ Six or more residential units ❑ Recreational vehicle parks
Ci /Slate /ZIP' Tigard /OR/97224 ❑ liealdr - care fucihuev ❑ Supply soilage for more than
.—. - -..... _.. -
..._ . . 0 Hazardous locations 600 volts nominal
Suite/bldg. /apt. no : Project name' ❑ Service or feeder 600 amps or more
SCHEDULE FEE
Cross street /directions to job site' Description 1 qt i , Pee. i Tmal i.t
New residential single - or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq 11 or less 168 54 4
Ea - add'l 500 sy ft or portion 33 92 I
Tax map/parcel no.: Limited energy, residential 75 (1(1 2
DESCRIPTION OF WORK (with above sq ft,)
— Limited energy, multi-family 75(1(1
Panel change and network receptacles residential (with above sq R )
Renewable Energy_ ❑ Seepage 2
Services or feeders installa_ti_on, alteration, and /or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less I 100 70 100 70 2
201 amps to 400 amps 133 56 2
Name' Robert Rath - r
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: Temporary services or feeders installation, alteration, and /or
Phone: ( ) Fax: ax: ( ) relocation
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
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
1. APPLICANT ❑ CONTACT PERSON A Fee for branch circuit with
above service or feeder fee, 2 7 42 14 84 2
Business name: PDX Electric each branch circuit
-- -- -- - - - - -- - -- - --- 13 fee Tot branch circuits wahnui
Contact name. Marty Palmer service or feeder fee, first 56 18 2
branch circuit
Address: 7933 SW Whitfurrows Ct I-xch add'l branch circuit 7 42 2
City/State/ZIP: Durham /OR/97224 Miscellaneous (service or feeder not included)
Each manufactured or modular 67 84 2
Phone: (503) 639 -9708 Fax: - (503) 200 -1362 dwelling, service and/or feeder
--------- -- - - -- ----- - - - - --
- -.. -_ Reconnect only 67 84 2
•
E-mail: info(i),pdxelectric.enm Pump or irrigation circle __ 67 84 2
CONTRACTOR Sign or outline lighting 67 84 2
Business name: PDX Electric Signal circuit(s) or limited- energy See -
_____ -_ - panel, alteration, or extension- _ _ Page 2 2
Address: 7933 SW Whitfurrows Ct Each additional inspection over allowable in any of the abov
City/State/ZIP: Durham /OR/97224 Additional inspection (I hr mm) (s6 25/hr
Investigation (1 ht mini 66,25/ hr
Phone: (503) 639 -9708 Fax: (503) 200 -1362 Industrial plant (I hr min) 78 18/ hi
Inspections for which no fee is y0,00/ hr
CCB Lie : 192731 Electrical Lie.: C696 Suprv, Lie.: 5612S specifically listed (V2 hr min) 1
ELECTRICAL PERMIT FF
Suprv, Electrician signature, required:
Subtotal: , 115 54 _
Print name: Marty Palmer Date. 6 - 25 - 13 Plan review (25% of permit fee).
/ y
State surcharge (12% of permit fee). 13.86
Authorized signature '/ ," ' ' / TOTAL PERMIT FEE: 129.40 c
'Phis permit application expires if a permit is not obtained within 180
Print name. t Date: days after it has been accepted as complete.
• Number of mow ion'. allowed per permit
I\ Build ,ng1Pernnis \E1,C'_PenmtApp_ri.R — rise doe Rev OS /71 Rrllt 440 -46 I ST( I I /052'OM,'WEB
6/25/2013 4:03 PM From: PDX Electric LLC / 503 - 200 -1362 To: 15035981960 1 of 3
PDX ELECTRIC
7933 SW Whitfurrows Ct
Portland, OR 97224
(503) 639 -9708
(503) 200 -1362
www.pdxelectric.com
info @pdxelectric.com
To: City of Tigard From: Marty Palmer
Fax: (503) 598 -1960 Date: 6/25/2013 4:03 PM
Phone: Re: Electrical Permit
Comments
Attached is an electrical permit application and a credit authorization form
f acs • imi
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