Permit CITY OF TIGARD ELECTRICAL PERMIT
l i g • COMMUNITY DEVELOPMENT Permit #: ELC2013 -00370
Date Issued: 07/02/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 7/02/2 A02100
Jurisdiction: Tigard
Site address: 11375 SW 95TH AVE
Project: Coleman Subdivlsion::HERS ADDITION TO GREENBURG HE Lot: 1
Project Description: Reground service for water line replacement.
Contractor: WILLAMETTE ELECTRIC INC Owner: COLEMAN, MATTHEW JAMES
PO BOX 230547 11375 SW 95TH AVE
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 -624 -3631 PHONE:
FAX: 503 -624 -2938
FEES
Quantity Description Date Amount
1 ea Reconnect Only 07/02/2013 $67.84
Specifics:
1 ea 12% State Surcharge - 07/02/2013 $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 95 -001 -1190. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987
Issued By: �- Permittee Signature: �� (J' �L��`��O
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.
07/01/2013 MON 16:51 FAX 5036242938 Willamette Electric RI 002/_002
Electrical Permit A • • 1� . t' w. ��;,` ` ;FOR OFFICE USE ONLi
C it y of Tiga ••• I ' 1 } R ec e iv 7 /3 A
p Received />• G
v — Permit No. Cc 3 Q
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= • 13125 SW Hall Hlvd., Tig:, d, •R 97223 .� plan Aeview d � ��
Phone: 503.639.4171 Fax: 5031111E19601 Z G 1 Date/By: Other Pcmn 4 / . / 0/3 o0.2.d3
TIGARD Inspection Line: 503.639.4175 '- DateReady/By: . 7uris: r i H See Page 2 for
Internet: www.tigard- or.gov _� &:,- ), �i A1, -2 N (� Supplemental Information
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❑ New construction Addi teration/replacement Please check all that apply (submit 2 sets of plans w/items checked below);
❑ Service or feeder 400 amps or more 0 Building over three stories
❑ Demolition Other: where the available fault current
y ' '' ' ( �:� exceeds 10,000 amps at 150 volts or ❑ Plo
Marinas and boatyards. .
.. TFG .. : ..... . . • . , N `_ . i N. - .... , _ _ .:_.:.. : . , .:_ :::: less to ground, or exceeds 14,000 Bring buildings.
1 and 2 family dwelling 0 Commercial /industrial ❑ Accessory building buildin am ❑ Commercial agricultural
amps far all other installations. buildings.
Multi family 0 Master builder ❑ Other: ❑Fire pump. ❑ Installation of 75 KVA or
❑Emergency system larger separately derived system.
; •3U 'S L )✓ t~ 1 lylA IU14 A1Vb: �;DC, 1I N ❑ Addition of new motor bond o[
Job no.: Job site address: J / 3 7 + ) ' (, 1 / = , WOW or more, occupancy.
❑
//� c r / � = (I � �� ❑ Six or more residential units. Recreational vehicle parks.
City /State /Z1P: �� � . 7 ❑ Health-care facilities. 0 Supply voltage for more than
( ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: roject name: � /' ❑Service or feeder 600 amps or mart.
J D e se
job site: ' ''' '
riPtion I Qty. I Fee. I Total : i :
Cross street directions to +
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4
- Ea. add'I 500 sq. R. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DI; "OF WORK (with above sq. R,) 75.00 2
• . ' ' Limited energy, multi- family
R e. 75.00 • 2 ', v 0 r J/ Set e V -r LY residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
201 amps to 400 am
❑ PItOPEttTY :OWNER ( lEitiANT, P amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 I
201 amps to 400 amps . 125.08 2
Owner installation: This installation is being made on property that i own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, Per panel
Owner signature: Date: A. Fee for branch circuits with
service or feeder f
e
AP.P1iOAT!IT. CI 7.42 2
above c ee
: . - , . . -• - ,, each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name:
branch circuit
. Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State/ZIP: dwelling, service and/or feeder
Phone: ( ) I Fax: ' ( ) Reconnect only / 67.84 67 fri 2
E - mail: Pump or irrigation circle 67.84 2
Sign or outline lighting
67.84
_ .. C G 'C iZ' .::- Signal circuit(s) or limited -energy
Business name: Willamette Electric Inc. panel, alteration, or extension. Paget 2
Each additional inspection over allowable in any of the above
Address: P.O. Box 230547 Additional inspection (1 hr min) 66.25/ hr .
investigation (1 hr min) 66.25/ hr
City/State/ZIP: Tigard, OR 97281 J
industrial plant (1 hr min) 78.181 hr
Phone: (503) 624 - 3631 • Fax: (503) 624 - 2938 Inspections for which no fee is 90.00 / hr
specifically listed ('h hr mm)
CCB Lie.: 75059 Electrical Lie.: 34 -283C Suprv. Lie.: 4226-S -
226 -5 :: MIZE 7tICitil l'BBMI`I? i ZES ::_ : :; :: ">
Subtotal: -
Suprv. Electrician signature, requ' a .. Plan review (25% of permit fee):
Print name: David Fife Date: -7///A3 State surcharge (12% of permit fee):
TOTAL PERMIT FEE: ? j 5i
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: • days after it has been accepted as complete.
Number of inspections allowed per permit.
l:\ Building \PermitAELC-PetmitApp.doe 07/01/10 440.4615T(l l /OS /COM/WEB