Permit A CITY OF TIGARD ELECTRICAL PERMIT
1,1 t;_, . COMMUNITY DEVELOPMENT Permit#: ELC2013 00481
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/14/2013
Parcel: 1 S134CD02700
Jurisdiction: Tigard
Site address: 11950 SW 119TH AVE
Project: Courtox Subdivision: LERON HEIGHTS NO.3 Lot: 62
Project Description: Grounding due to water service replacement. -- - - -
Contractor: BOONES FERRY ELECTRIC INC Owner: COURTOX, ROBERT L AND
PO BOX 628 DOROTHY
WILSONVILLE, OR 97070 11950 SW 119TH
TIGARD,OR 97223
PHONE: 503-682-4936 PHONE:
FAX: 503-682-7946
FEES
Quantity Description Date Amount
•
1 crt Branch Circuits wo/Purchase 08/14/2013 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/14/2013 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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. ATTEN : Or-•, law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules .are set forth in OAR
952-001-001 through OAR 95 00 ,'90 You may obtain a copy of the rules or direct questions to OUNC by calli. 03:232.1987 or 1.800 332.2344.■ i
Issued B v AL �f�► v Permittee Signatur • �� ,'!�.►J/ rc--,2___,
v
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 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.
Aug. 12. 2013 4:42PM No. 1126 P. 3
Electrical Permit Applicat ttE�• D FUR 011.i(:I: 1_:SIB O'LLl.
III.... City of Tigard rl ,� /4 13 CLAI Poragt No.:G u•al()/3-as 8/
• 13125 SW Hall Blvd-,Tigard,OR rent: 1 Plan Review /�
Phone: 501639.417I Fax 503.598.1966(01 1 LI 2 013 ugY . �Permit: 1'(.al A6 /3 -00,2442
T I G n R 0 ' Inspection Line: 503.639.4175 Date Ready/By: ®Ses.P 2 for `
Internet www.tigard•or.gov CITYOFTIGARD Nodfied/Method: . �a�t IInformadoa
❑New construction .1I Additio falteta iOn/replacement 1 cheek all that apply(submit 2 ads of plans w/dams clacked below):
[]Demolition ❑Other ❑Service or feeder 400 amps or more ❑Building over three stories.
: 4 l ,j` ' why the available atilt Current D Marinas and boatyards.
ids WAD amps at 150 volts or ❑Floating buildings.
ground,m exceeds 14,000 ❑Commorr:ial-use agrjeyllma]
N- leas to ground,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
r ,J r ri ti ❑Emergency system. larger separately derived system.
• , ,t'_, _ ;._, ,.A_.,:. . _ ..,..,.. x. ..,.. ..., .. . , .,.., s __s__ _,«.;.,`yw .'_._.:j..._�.:.�' OAddufoaof new muter laud of 0'A°."E","1-2","1-3°,
Job no.:..2.38 3 Job site address: 1 19 5 O 51v ) 3 A v 100I1P or more. occupancy.
9 ❑Six or more residential units. ❑Recreational vehicle parlm.
City/State/ZIP: 'r'f y qv, 0 o- ❑Health-care&edifies. 0 Supply voltage for more than
❑
1 ,laws locations. 600 volts morainal.
Suitefbldg./apt no.: I Project name: ?a $3 CO V r 4 4 te
❑Service or feeder 600 amps or mo .
�
-:�( F:3.-i _._.—..-. : S:. :: ev:' Y'e,
Cross street/directions to job site: .. '� #0 •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq.ft or less 168.54 4
Tax map/parcel no.: Ea.add;1500 sq.it or portion 3392 1
' Limited energy,residential
67.84 2: s,z , . : 7 �n m ` r (with above sq.ft.)
. .
Limited energy,mold-f8mily 6714 2
9 r o U yt 1 \g G 4 .�,p r+/'w 11 n �04% residential(with above sq.ft.)
J Services or feeders inseallationtalteration,and/or relocation
200 amps or less 100.70 2
2 5- 7� 3 3 201 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
•
.ddress: Ode!1,000 amps or volts 55226 2
City/State/ZZ1P: relmpora services or feeders installation,alteration,and/or
Phone:( ) Fax:( )
200 amps or less 59.36 I
Owner installation:This installation is being made on property that I own which is not 201 aalga to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 to 599 aepps 168.54 2
Branch circuits—new,alteration,or extension,per panel
Owner signature: Dare: k Fee for branch circuits with
o F { } 4 i } above service or feeder fee, 7.42 2
y'-"... ._R... .......;...,. . !....} .........:-1.:.\.'..'..�{: :_1�_.._f_:. .{...,::A.. .'..... ....n........ _... each ch circuit
Business same: B.Fee for branch circuits without
service or feeder fee,fast i 56.18 2
Contact name: branch circuit
- _ Each add'I branch circuit 7.42 2
Address: Miscellaneous(service or feeder not included)
— Each M3Mactured or modular City/StateJZIP: dwelling, and/or feeder 67.84 2
Phone:( ) I Fax::( ) Rexonntrt 00b 67.84 2
Pump or irrigation circle 6714 2
E-mail a lighting 67.84
{ Si®o or outlm li 2
. .,.;',-,,,.,]:..'s:,,,,,,,:.,,,,..;,,,,
,,,,.. .... .... . ... ...... _._.,.. . _.. !, n . ,7 - .... Signal cin uit(s)or limited-energy
Business name:Booties Ferry Electric panel,alteration or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address:P.O.Box 628 Additional inspection(1 lir ruin) L 6625/hr
—City/State/ZIP:Wilsonville OR 97070 1m16°ton(I hr min) 78.18/hr
__ Industrial plant(1 hr mm) 78.18/hr
-Phone:(503)682-4936 Fax:(503)682-7946 Inspections far which no fee is yo.oa fu
CCB Lic.: 88482
tlil
Suprv.Electrician signature,' Elccimecl aLic.: 3-223C s fi listed 4 hr mm)
_
`Su pry Lie.: 770 ,- _ � , ...._..
Subtotal: 5.6` 9
Plan review(25%of permit fee): ,,
?tint name: Date: 8/(:V� ^3 State surcharge(1296 of permit fee): g, 7 ►�
s.+7 Qi YeJ�e TOTAL PERMIT FEE: I (1_2 .91.
Authorized sign,. c'1 I, ...,..r.,,. •'. ��./ 'Ibis permit appreciation expires da permit is not obtained within 180
��/ �, days alter it has been accepted as completm 1
Print name: \11!i �/)l.�< J l Daze: • Number of inspections allowed per pemit Q�1vI'/
l:1 HuddmePermiteoE1.C-PermNApp.doe 10,01/09 440-4e151(11/05/COMroIE3
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