Permit u CITY OF TIGARD ELECTRICAL PERMIT
- COMMUNITY DEVELOPMENT Permit #: ELC2013 -00409
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/22/2013
Parcel: 25111 DC10700
Jurisdiction: Tigard
Site address: 15720 SW OAK MEADOW LN
Project: Dunlap Subdivision: SUMMERFIELD NO.11 Lot: 603
Project Description: Change panel and install grounding
Contractor: TNT HOMES & ELECTRIC Owner: DUNLAP, GERALD M TRUST &
12856 SE SILVERLEAF CT DUNLAP, REBA L TRUST
MILWAUKIE, OR 97222 15720 SW OAK MEADOWS LN
TIGARD, OR 97224
PHONE: 503 - 656 -0862 PHONE:
FAX: 503 - 656 -0862
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/22/2013 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 07/22/2013 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports (Conditions)
This permit ssued subje = the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don in accordance with appro -d plan . is 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 req i you to •flow the rules adopted by the Oregon Utility Notification = ter. T1 • _ • =s are set forth in OAR
952 01 -0010 thro 1gh OAR 952 - 001 -0 You • ay ob - n a copy of the rules or direct questions to OUNC by calling 503. :' 0.332.2344.
s
I7
I sued By: �/11 �i� Permittee Signature: II i �•,•
•
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:
RACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Al I _ Date: 76010_/ 3
LICENSE NO.
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 Applicati FOR OFFICE USE ONLY
Received ®`'
7
Permit of Tigard DateB : / Pit No.: &645 /
q 13125 S W Ha Blv d, Tigard, OR 97223 Plan Review
IN
C . 2 2 G Other Permit: :
Phone: 503.718.2439 Fax: 503.598.1
4 2 13 Date/By.
TIC A 1: D Inspection Line: 503.639.4175 Date Ready/By: tuns: e See Page 2 for
Internet: www.tigard - or.gov CITY OFTIGARD Notified/Method: Supplemental Information
. . ` , ; TYPE (>@litIffitNG DIVISION _' .: ; " -. PLAri iiEvIEW _ .
❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑ Other: where the available fault cuimrat ❑ Marinas and boatyards.
,;; ;CATE "OF CONSTRU - , . =_` =� s. - . - -
exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
dwelling Commercial/industrial Accessory building amssoorall other a exceeds o s, ❑ Commercial -use agricultural
1- and 2-family � ❑ ❑ ry g amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 150 KVA or
❑ Emergency system. larger separately derived system.
- . JOB. SITE INFORMATION AND . LOCATION. - ❑ Addition of new motor load of ❑ "A ", "E ", 1-2 ", "1 -3 ",
Job no.: Job site address: is ZV SW ® 100HPormore. occupant}.
❑
�' T 0 or more residential units. Recreational vehicle parks.
City / State/Z1P: N 6 I ' , at j 0 ! 1 -- ^ ❑ Health -care facilities. 0 Supply voltage for more than
/� J 1-✓T ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: f Project name: ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: 1��J) _ FEE.._SCH "
j U 1,4 AA. / J / .er Ef oi9� I Qty. 1 Fee I Total •
6D 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'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential 75.00 2
' -..:: `"
DESCRIPTION OF' WORK_ (with above sq. It)
y Limited energy, multi- family
t��a.l� J•e_ p. N e' 4 i t. 1 — � )i 1 , )9 D N residential (with above sq. ft.) 75.00 2
'Renewable Energy ' I ❑ See Page 2 -
Services or feeders installation, alteration, and/or relocation
❑• PROPERTY W
,ONER . , I - -, ❑ TENANT ' 200 amps or less I 100.70 2
201 amps to 400 amps 133.56 2
Name: 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: ( ) I Fax: ( ) r ' eO ' On -
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
s.❑ APPLICANT = .: _: [],.CONTACT -- PERSON _ ,
A. Fee for branch circuits with
above service or feeder fee, 7.42 2
Business name: each branch circuit
B. Fee for branch circuits without
Contact name: service or feeder fee, first 56.18 2
branch circuit
Address: Each add'I branch circuit 7.42 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular
67.84 2
Phone: ( ) I Fax: : ( ) dwelling, service and/or feeder
Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR _,'> Sign or outline lighting 67.84 2
Business name: 1-1U-1- I+ UiM 5 4 5. I et ."'t (I c- Signal circuit(s) or limited- energy See
panel, alteration, or extension. Page 2 2
Address: I 54 5 6 5 j ( . (.e.„ ^ , dt • Each additional inspection over allowable in any of the above
City/ State/ZIP: W ` 1 y9a.0 J e e D r L ` 19 _ Additional inspection (1 hr min) 66.25/ hr
_ ! ' 2.1...2._ Investigation (1 hr min) 66.25/ llr
Phone: (6 3 ) to .. f�' O 06'2— I Fax: 6 )) 10 56 V h4 Industrial plant (1 lir min) 78.18 / hr
Inspections for which no fee is 90.00/ CCB Lic.: ' < ' Electrical Lic.: .�- a . Suprv. Lic.: - specifically listed (V2 hr min)
/ , `i - _ i o h I i ELECTRICAL - PERNIIT FFF ' : ° - : _ ? -
Suprv. Electrician signature, required: ( „ w Subtotal: O
—
Print name:R ;‘..10t, t t , i ‘ / . i . Date: 1 ?j Plan review (25% of permit fee): ...............----7 '
1 State surcharge (12% of permit fee): ig. °T
Authorized signature: TOTAL PERMIT FEE: if A_ 7f
This p ermit application expires if a permit Is not obtained within 180
Print name: I Date:
.lava after it hue Man arrnnt.vi se rmm�lnto