Permit CITY OF TIGARD ELECTRICAL PERMIT
•
COMMUNITY DEVELOPMENT Permit#: ELC2013-00508
T I G pR O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/27/2013
Parcel: 2S103AD06400
Jurisdiction: Tigard
Site address: 12695 SW 111TH PL
Project: CORNELIUS, Subdivision: WILDERNESS Lot: 10
Project Description: Panel replacement.
J
Contractor: BOONES FERRY ELECTRIC INC Owner: CORNELIUS,JOSHUA&JESSICA
PO BOX 628 12695 SW 111TH PL
WILSONVILLE,OR 97070 TIGARD,OR 97223
PHONE: 503-682-4936 PHONE:
FAX: 503-682-7946
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 08/27/2013 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 08/27/2013 $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 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 OA -001-0090. You may obtain a of the ru uestions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By e_ __ ___ Permittee Signature: %•"".
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. 23. 2013 3:46PM No. 1188 P. 1
• •Electrical Permit A l l� SaF :
FOR OFFICE C'SE ON L1
City Of Tigard . . oo Received
III DmslB . 7 �i Pe®f No.: yq%C,� _ �.
13125 SW Fled Blvd.,Tigard,O)t 3A 6 2013 Plan Review'
Phone: 503.639.4171 Falc 503. r j : Other Permit
r 1G,;R n In F lTY O TIG1R D � iter Line: el 80v le _ sSapple tal for fo, w
-- .-•..._..... .._.. _ nCL...\ ^..�,._ __-�L; M1w:�..4 -.'''''''''..t'''-',. �.f ./n ' .. `
❑New construction ,„.../K1 Addition/alteration/replacement 1 c that apply(submit 2 seta ofplans wrrt�elude4 below):
❑Semite ar feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other. where the available fault=rent ❑Marne and boatyards.
- + r J ?. , , j .y r exc�ds'Qom romps m 15O volts or ❑Floating buildiaga. .
-,._ ._.._ _.■r -.c,...._ i.. ... •—; __ less m ground,or exceeds 14,000 ❑Commercial-use agiwloo.4
1-and 2-faQllily dwelling ❑Commercial/industrial ❑Accessory building - saps for all other installations. buildings
❑Multi-family ❑Master builder ❑Other. 0 Fire pump. 01osafation of 75 KVA or
v > I?mrsgency system. larger separately derived synere
r '/. t< �4 ;�: t r f` " `, ❑Addition of now motor load of 0"A"."E', 1-2"."1-3",
Job no.:22 36 7 Job site address: /.2 6 9 5 5 , /J six or or mine off.
❑Six ar more residential omits. ❑Recreational vehicle peeler.
City/State/ZIP:-F;is,,,,,..4. O Health-care facilities. O Supply voltage for more Chao
❑Hazardous locarioos. • 600 volts nominal
Suite/bldg./apt.no.: I Project name: Coin e I I vs 0 Sainte or feeder 600 amps or more
- - ? ter, r 5 1 1�� ,r x :n
Cross street/directions to job site: _naeryoot 01v.. .... ..F ..�. Todh -
New residential single-or multi-family dwelling unit:
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq.B or less • 168.54 1 4
Tax map/parcel no.: Fa.add'!500 sq.R or portion 33.92 . 1
Limited cacrgy,residential
67, 2
with a e R
e p -1 iad etler�,mulu•fBmilY 67.84 2
P�''/"lt 4 0 E' i ur►E 1 C to 2 (ta' he,-) residential(with above sy.R
Services or feeders installation,alteration.and/or relocation
200 turps or less j 100.70 2
N:` c .r A, 5,. ` Y 201 amps to 400 arrips 133.56 2
....... 401 amps t0 600 amps 20034 2
Name: 601 amps to 1,000 amps 301.04 2
des; Over 1,000 amps or votes gig 552.26 2
City/State/ZIP: e a Temporary services or feeders installation,alteration,and/or
City/State/ZIP:
Phone:( ) Fax:( ) 200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 to 400 stops 168.54 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps - 168.54 2
Branch circuits-new,alteration,or eIIeoaioo,per panel
Owner signature: Date: A.Pee for branch circuits with
K; e above service or feeder fee, 7.42 2
r:J"-_,... .....:......:.•_ ..r -c..., ..::__,.:_,.a_._. __._ _,--`.-. '.�.:: ea�h branch eutntt
Business name: H.Fee for branch circuit without
service or feeder fee,first 56.18 2
Contact name: .
circuit _ _
Each add'l branch circuit 7.42 2
Address: Miseellaneons(service or feeder mot indadcd)
City/State/ZIP: dwW se and/or feeder 67.84 2
Phone:( ) I Fax::( ) Reconnect only 67.84 2
Pump or irrigation circle _ 67,84 2
E-mail: Sign or outline lighting 67.84 2
-� - to 13 - 1
., ._.:...,. .......: .:. ...,....., ,�,......;.v...,_ -_.., _. ._.�.,::. signal cvtuit(s)orlitlured.crlergy
Business name:Boones Ferry Electric panel,al on or ecomsicm. Page 2 2
_ Each additional inspection over allowable in any of the above
Address P.O.Box 628 Additional inspection(1 hr mite) 6625/hr J •
Iovestigaaion(1 br nisi) 6625/hr
City/Stare/ZIP:Wilsonville OR 97070 -hulinaial plant(1 br min) 78.18(1r
Phone:(503)682-4936 Fax:(503)682-7946 Inspections for which no fee es 90.00/hr
.: listed %to min)
CCB Lic.: 88482 Electrical Lic.: 3-223C Suprv.Lic.: '3 71.S .';,.',3,-.--.'",. >. `..: .....__ ...._..
Subtotal; (00 :7,
Suprv.Electrician signature,required: / / } . Plan review(25%of permit fee): -- . Q
?riot name: 1.0,0 , C✓Y•� 1 Date:S /Z 3/ 1 1 — State (126/6 of permit fee): ?l. -
TOTAL PERMIT FEE: l j z,�6
Authorized signature: This permit application expires if a permit is not obtained within 180
y i � +J� � days ate It has been accepted as complete
Pritrt name' J ,� r� y Date: e�3 d• ' • Number of inspections allowed per permit.
lmkildinuaGrmdimC-PerrnitApp.doc 10101/09 440.4615T(1 UOS/COM/VEB