Permit CITY OF TIGARD ELECTRICAL PERMIT
11111 s COMMUNITY DEVELOPMENT Permit#: ELC2014-00145
T i
GAR O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/31/2014
Parcel: 2S114AA00200
Jurisdiction: Tigard
Site address: 16285 SW 85TH AVE 103
Project: Happy Campers Subdivision: 1993-078 PARTITION PLAT Lot: 2
Project Description: Panel replacement and modifying(2)branch circuits,
Contractor: CROWN VOLTAGE Owner: WH SHIPMAN LIMITED
609 SW EATON BLVD BY NORRIS&STEVENS INC
BATTLE GROUND,WA 98604 621 SW MORRISON STE 800
PORTLAND,OR 97205
PHONE: 360-666-0995 PHONE:
FAX: 360-666-4673
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 03/31/2014 $100.70
Specifics: amps or less
2 crt Branch Circuits w/Purchase 03/31/2014 $14.84
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 03/31/2014 $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 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
9
Issued By: 'flee Signature: __ �/ .. ..- ..
C 11103111 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.
Electrical Permit Application FOR OFFICE USE ONLY
p—
City of Tigard - Received --r
III
13125 SW Hall Blvd.,Tigard,O 'l "� r. Dale/B : ;.-7 / mil •-rmit No.: _Da .�
= Plan Review
Phone: 503.718.2439 Fax: 503.5 .1960 Da1e/By Other Permit:
Inspection Line: 503.639.4175 if ,1 ?'l-'4 Date Ready/By: Jutis
TIGARD p �. i` 1 l�l See Page 2 for
Internet: www.tigard-or.gov Notified/Method: .6, Supplemental Information
TYPE OFgWORK PLAN REVIEW
CI
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 stories.
❑Demolition CI 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-fancily dwelling ®Commercial/industrial El Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A "E '1-2 "1-3",
Job no.:C13350 Job site address: 16285 SW 85TH AVE I001-IP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:TIGARD OR 97224 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: 103 Project name: HAPPY CAMPERS ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
Description I Qty. I Fee. f I'mxt 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
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
REPLACE ELECTRICAL PANEL AND MOD 2 CIRCUITS residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑.TENANT 200 amps or less I 100.70 100.70 2
' 201 amps to 400 amps 133.56 2
Name: HAPPY CAMPERS 401 amps to 600 amps 200.34 2
Address: 16285 SW 85T1t AVE 601 amps to 1,000 amps 301.04 2
City/State/ZIP:TIGARD OR 97224 Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Phone:(208)2556698 Fax:( ) relocation
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
® APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, 1 7.42 14.84
Business name:CROWN VOLTAGE INC each branch circuit
B.Fee for branch circuits without
Contact name:STACY LACOMBE service or feeder fee,first 56.18 2
branch circuit
Address:609 SW EATON BLVD Each add'I branch circuit 7.42 2
City/State/ZIP: BATTLE GROUND WA 98604 Miscellaneous(service or feeder not included)
Each manufactured or modular 67 84 2
Phone:(360)6660995 Fax: : (360)6664673 dwelling,service and/or feeder -
Reconnect only 67.84 2
E-mail:CROWNVOLTAGEINC @AOL.COM Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: CROWN VOLTAGE, INC Signal circuits)or limited-energy Sec
panel,alteration,or extension. Page 2 2
Address:609 SW EATON BLVD Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
City/State/ZIP: BATTLE GROUND WA 98604
Investigation(1 hr min) 66.25/hr
Phone:(360)6660995 Fax:(360)6664673 Industrial plant(I hr mm) 78.18/hr
33zZ tilt Inspections for which no fee is
90.00/hr
CCB Lic.: 153934 Electrical Lic.: 3f-984C Suprv.Lic.: 57778 specuically listed(%=hr mm) _
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 1 15.54
Print name: DANIEL TUCKS' Date: 3/18/14 Plan review(25%ofpermit fee):
State surcharge(12%of permit fcc): 13.86
Authorized signature: .�I TOTAL PERMIT FEE: 129.40
Print name: This permit application expires if a permit is not obtained within 180
tL' days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:1Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440.461ST(ii/05/COM/wEti