Permit CITY OF TIGARD ELECTRICAL PERMIT
1 a COMMUNITY DEVELOPMENT Permit #: ELC2013 -00395
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439. Date Issued: 07/11 /2013
Parcel: 2S111DD06500
Jurisdiction: Tigard
Site address: 15800 SW STRATFORD LP
Project: Wiebe Subdivision: STRATFORD Lot: 62
Project Description: (3) branch circuits for bathroom remodel
Contractor: ARON ELECTRICAL CONSTRUCTION LLC Owner: WIEBE, SUE ELLEN REVOCABLE LIVIN
15704 NE 70TH ST 15800 SW STRATFORD LOOP
VANCOUVER, WA 98682 TIGARD, OR 97224
PHONE: 503 - 516 -3139 PHONE:
FAX: 360 - 882 -7978
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 07/11/2013 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/11/2013 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 ' accordance •• approv- • plans. This permit will expire if work is not started within 180 days of •ance, or if work is suspended for more the 180
days. TTENTION: Oregon a , req i - you to follow the rules adopted by the Oregon U " r • Center. Those rules are set forth in OAR
952 01 -0010 through OAR 95001-009 may obtain a copy of the rules or direct questions to 0 C • 987 or 1.800,33 344.
1 sued By: L / P e rmittee • ignature: ') �� ' �J�g" CC
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' - 1j4 e0W c Date: 7 //
LICENSE NO. � o S
Call 503.639.4175 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.
Electrical Permit Application FOR 01' I 1(1 I S1 :ON1.1
City of Tigard W
� a Received Permit No
�`L.Ga'�v /3 " 3
• 13125 SW Hall Blvd., Tigard, OR 972 Phone: 503.718.2439 Fax: 1 DateBy: 7 /3 Plan Review
: 503.598.1961 DateB y: Other Permit:
Inspection Line: 503.639.4175 JUL 1 L 1 1 2013 Date ReadyReady/By: kris: is: ® See Page 2 for
Hi.; li A It t)
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
OF rA
E OF WORMY O TIunKD. . , PLAN RE. VIEW ' ' _ ' ',
❑ New construction Hi Addition/alterat , VISION Please check all that apply (submit a sets of plans w /items checked below):
►U1f`I ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
'.JOB_STTE , INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
' �^� ^ a / � � � 9! 1 l Six or or more. occupancy.
Job no.: Job` site address: "SD J V t/ 1 loo Recreational vehicle parks.
^ � 0 or more residential un ❑ p
City/State /ZIP: t t� ®� ._ Z ❑ He
zardouse locations. ❑ Supply voltage for more than
k \7 I I ❑ Ha�ardaus locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
' FEE , SCHEDULE , .
Cross street/directions to job site: Description I Qtv. I Fee. I Total I • -
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. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF W011tlt:. • , „ ' ' (with above sq. ft.)
` `` Limited energy, multi-family 75.00 2
L('OO^r. I`t -OBIB1 . (� 0\< `t'Lio Ms) Catea6 <,(J residential (with above sq. ft.)
e Services or feeders installation, alteration, and/or relocation
� es-Si -1 A„ \. Q) ot, v� GP-CT i (C r\-6-<A f 200 amps or less 100.70 2
0 PROPER. OWNER ' ' • I TENANT 201 amps to 400 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
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
APPLICANT I ❑' CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without b
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 2. 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: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
CONTRACTOR ' Signal circuit(s) or limited- energy
Business name: p Q p to C L E C ( p- Co.4 51' C c (0 ti L `- panel, alteration, or extension. Page 2 ble in any of the above 2
'T I E ach additional inspection over allowa
Address: ( ) / 1) 1 1 0 \-‘,., •r - f 1 Additional inspection (1 hr min) 66.25/ hr
k ' ' 6 In plant (1 hr min) Investigation (1 hr min) 66.25/ hr
City/State/ZIP: 1 (`c O /State /ZIP: 78.18 / hr
�_ � Vv Z
61 8 (�
Phone: (503) ca- 3 ( ;i Fax: (3 b 0) a 2 - 7 9' 78 Inspections for which no fee is 90.00/ hr
specifically listed (V2 hr min)
CCB Lic.: l�) 2 - 1 ( .t Electrical Lic.: C. 8 3 Suprv. Lie.: 5�8$ S • . ELBC` 1 ICAL 'PERMIT FEES •.
• / %It s v, /, y /c%// 3 Subtotal: 7(• t
Suuprv. Electrician stggggnature, required: Plan review (25 % of permit fee): i
Print name: c) yp y LfZ" C 9 -- Date: - (9/ i 3 State surcharge (12% of permit fee): 8 • y a- TOTAL PERMIT FEE: 79 .5 - Lf
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: >3 71::: � L,l, i\--a-) k Date: 7 /9/(5 days after it has been accepted as complete.
Number of inspections allowed per permit.
1:\ Building \Permits\ELC•PermitApp.doc 07/01/10 440 -461ST(II /05 /COM/WEB