Permit CITY OF TIGARD ELECTRICAL PERMIT
1111 G COMMUNITY DEVELOPMENT
Permit #: ELC2013 -00375
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/03/2013
TIGARD Parcel: 2S111CD06300
Jurisdiction: Tigard
Site address: 9839 SW KIMBERLY DR
Project: Sayre Subdivision: KERWOOD ESTATES Lot: 24
Project Description: (1) 200 amp service and (2) branch circuits for panel change, RV and hot tub circuits.
Contractor: WEST SIDE ELECTRIC CO INC Owner: SAYRE, MELVIN E & BERNICE A
1834 SE 8TH AVE 9839 SW KIMBERLY DR
PORTLAND, OR 97214 TIGARD, OR 97224
PHONE: 503 - 231 -1548 PHONE:
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/03/2013 $100.70
Specifics:, amps or less
2 crt Branch Circuits w /Purchase 07/03/2013 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 07/03/2013 $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 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 9 -001 -0 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. .
Issued By: /l {, i Permittee Signature:
Ai 'IV 9-770 n/
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 503.639.4176 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.
2013 -07 -02 04:16 WEST SIDE E�L �l,r
E 15037360677 » 5035981960 P 2/2
Electrical Permit Applicatio roi( e;rri(i: i I: e.1.1.)
Inspection Line: 503.639.4175 OF
City of Tigard Received S W Heil Blvd, Tigard, OR 97223 JUL J U L 0 2 .2 0 � 3
Plan Review 7 •/ •- , / ' /
' _ ` ` Phone: 503.7182439 Fax: 503.598.} TIGARD Date/9 '
I I c , F ; i > 1.1 Jl i Other Permit:
Date Ready /By: BM Hi See Page 2 for
Internet: www-tigard-or'gov BUILDING DIVISION Notified/Me had: Supplemental Information
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❑ New construction `.t Addition/alteration/rcplacement Please check all that apply (submit A sets of plans w /¢ems checked below):
❑ Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other where the available fault current ❑ Marinas and boatyards.
.r P , li' r+�M ?','rA ' r,,: ;fi `�` 5r 4 T Xfi50.� r " t ) �. ' - exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
, ' ` "� " n,." ` ' y - less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
i!I 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings_
❑ Multi - family 0 Master builder ❑ Other: ❑ Fire pump. ❑ installation of KVA or
., _ - „r ❑ Emergency system, larger separately derived system
� ;�N�;' "� :•h'• - y ��r��r�,�;;�� ? s'�•'b', , ,..k:,. f new motor load of "A", ,.E....1.2....1.
. -i /� 100HP or more. occupancy.
Job no.: \ I Job site ad ass: l J ' / ti "c � �7 i �r ❑ Six or more residential units. ❑ Rareai' al vehicle parks.
J /1 f j76;15 (� 7 2 J c/ // ❑ Health-care facilities. ID Supply volute for more than
City /StateJZ1P: / /G)G'r2 (1 ---((( ( (-
/J ( ❑ Hat�'doua locations, 600 volts nominal.
Suitc/bldg. /apt. no.: Project name: J1 /� )71,-.74”, ❑ service or feeder 600 amps or more.
Cross street/directions to job site: Description 1 ow, I Per. j Total 1
New residential single or multi - family dwelling unit
includes attached garage. _
Subdivision: Lot no.: 1,000 sq, ft. or less 168,54 4
Ea. add'I 500 sq. R. or portion 33.92 - 1
Tax map /parcel no.: Limited energy, residential
' .. x :... ,i y .., .. mo ��rt� k r '..11.9...,,,:;-.47.T.,._?';,
(with above so, ft.) 75.00 2
'd ..> Z�! F' ti t ..' t �r� .:, . l ,/ / Limited energy, multi-fatuity 75.00 2
a /'. r / / C�!•L!i/i r - /C ) 6.. • C ( /74/44 i // /- residential (with above aq. ft.)
/ • Services or feeders Installation alteration, and/or relocation
C / (L )/ /. 200 amps or less / 100.70 /pp ?' ( 2
r tt � ' I ti ivy g j " 201 amps to 400 amps 133,56 2 • w $vv .: W t o `. � ..,, ' iG®rmEsigi., ' . + , +:
:,., �i' . 1.1 4 , , , ,3 . r iaa AA % � iN.or PG : il; 2
401 amps to 600 amps 20034
Name: 601 amps to 1,000 amps 301.04
Address: - Over 1,000 amps or volts 552.26 21
Temporary services or feeders Installation, alteration, and/or
City /State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 wipe or less 59.36 l
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - atteretion, or extension r panel
Owner signature: Date: A. Fee for branch circuits with y
x. °n Qy$�.�1r L : i t - ;;° above service or feeder fee. 7-42 L - 2
.,,A;4k S` :, , s:TiM {SU2ieM1R,am i 1'.4 . 3af : ��_ r i . ^+ 1 �ll,n'r,.. z /
r•� ,a, =.��'' each
Business name:
H. 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: dwellin: service and/or feeds 67,g4 2
Reconnect only II
Phone: ( ) Fax: ( ) — Pump or irrigation circle 67.84 __ 2
E - mail Sign or outline lighting 67.84
" , c'tl5 rt8'.::`3 r�. - '4, ' `'R 7 - , '. k�i Signalcitcuit(s)orlimited- energy 2
. «.
.anal, alteration. or extension, Pe.
Business name: West Side Electric Co., inc. Each additional Inspection over allowable in any of the above
Address: 1834 SE 8 Ave. Additional inspection (1 hr min) 66.25/hr
Investigation (I hr min) 66.25/ hr
City/State/ZiP: Portland/OR/97214 industrial plant (l hr min) - 78.18/ hr
Phone: (503) 231 - 1548 Fax: (503) 736 -0677 Inspections for which no fee is 90.00/ hr
s • 'Scan iieted��4 hr mm
E lectrical Lic.: 26 -135C Suprv. Lie.: 4634 -S ':;' u,�t' " e:l' ?�!: ■ ;; !∎`:r
CCB Lie.: 13306 _ Subtotal: /
Suprv. Electrician signature, require. - , 1 • '4 �r� /.. ..-47- Plan review (25% of permit fee): MIMI
Print name: Randall F Roberts Date: State surcharge (12% of permit ice):
- TOTAL PERMIT FEE: .
Authorized signature: This permit application expires If a permit is not obtained within 180
days after It has been accepted as complete.
Print name: I Date: • Number of inspections allowed per permit. /�% , J 0
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