Permit Support Document ELECTRICAL PERMIT
CITY OF TIGARD io �g
2 • COMMUNITY DEVELOPMENT Permit#: ELC2014-00564
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/01/2014
Parcel: 2S 102CCO2700
Jurisdiction: Tigard
Site address: 13965 SW 102ND AVE
Project: Dave Arend Subdivision: FRELEON HEIGHTS NO.2 Lot: 11
Project Description: New Meter Mast. 10/28/14,adding(8)branch circuits.
Contractor: PDX ELECTRIC LLC Owner: TAYLOR, PETER H&BONITA J
7933 WHITFURROWS CT 13965 SW 102ND AVE
DURHAM, OR 97224 TIGARD,OR 97223
PHONE: 503-997-1989 PHONE:
FAX: 503-200-1362
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 10/01/2014 $100.70
Specifics: amps or less
8 crt Branch Circuits w/Purchase 10/28/2014 $59.36
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 10/28/2014 $19.21
Electrical
Type of Const:
Occupancy Grp:
Total $179.27
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 acc. •- 4 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. ATT• • ION: Oregon -w requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001 4010 through OAR 952-0,' •69r' may obtain a copy of the rules or direct questions to OUNC 03. 32.1987 or 1.800. 32.2344.Art
Ise ed By: /7 Permittee Signet
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.
To Page 1 of 1 2014-10-27 20:01:47(GMT) 15032001362 From Marty Palmer
nElectrical Permit A t tl opAC n FOR t1l 1-It r I ,I. if\i 1
City of Tigard �t�it 7Q 2014 Received Permit No.. E/.C.7 01/] -. rte; (:'_E
• 13125 SW Flail Blvd.,-figar T9 2 Plan Review --� —
Phone: 503.718.2439 Fax: 503.598.1960 Recei5s. Otter Permit
T 1 G A R la Inspection One: 503.63h.14E1V OF TIGARD Dale Ready/l3y: orris 0 Sec Page 2 for
Internet: www,ligard-or. Notilied/Mcthod: Supplemental Information
BiatigNitiraSION !IAN REVIEW
❑New construction ...3ErAddition/alteration/replacement Picric check at that apply(submit 3 sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stones.
❑l)emoliti011 ❑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,(100 ❑Commercial-use agricultural
gg,I-and 2-Family dwelling ❑Commercial/industrial ❑Accessory building amps for all otherinsiallations. buildings.
❑Multi-family ❑Master builder ❑Other:_ ❑Fire p,uup. ❑Installation 01 150 KVA or
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A""L'"'"1-2""1
Yid 100111'or more. occupancy.
Job no.: Job site address: 7 Cpr.. C C(� t1 a ❑Six or more residential units. ❑Recrea(1auab vehicle parks.
City/State/ZIP: -c t ca , [S C.)w c:T-� I z ❑Health-care facilities. ❑Supply voltage for mom than
_ ❑Hazardous 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: I Deseriptiea Ion'. I_ Fee. _I roh•t 1 •
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'1 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: _..__ Limited energy.residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
v Limited energy,multi-family 75.00 2
n residential(svryth shove sy.ft.)
K.YV1L✓4-, - vk Onto" D ii1t %r1cmiw-c.(l r
i t residential
Energy ❑ Sec Page 2
v ,,''`'" l.-7:iv':AA-,r r k',G.)4't.( 1)r.t.11'1')r'n f` ( I US r_- Services or feeders installation,alteration,audio r relocation
... .__ _...-__ I 200 amps or less 100.70 2
❑ PROPERTY OWNER TENANT
I 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
relocation
Phone:( ) Fax:( ) 200 amps or less j 59.36
Owner installation:This installation is being made on property that i own which is not 201 amps to 400 snips s 125.08 2
intended for sale,(case,rent,or exchange.according to ORS 447,449,670,and 701.
40I amps to 599 amps 168.54 2
r Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
`C ❑ APPLICANT I ❑ CONTACT PERSON A.Fce for(ranch circuits with
above service or feeder fee. 7.42 2
V.I sJ Business name:
each branch circuit T__ -----
B.fee for branch circuits without
V Contact name: service or feeder fee.first 56.18 2
branch circuit
`' Address: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: — _ Each manufactured or modular 67.84 2
dwelling,service and/or(coder
Phone:( ) Fax::( ) Reconncet only 67,84 2
d E-mail: Pump or irrigation circle 67.84 t 2
k CONTRACTOR Sign or outline lighting 67.84 . 2
-Signal circuit(s)or limited-energy f Sec:
1,1 Business name: `' c -f-v l 2
p K r_ t (' _pastel,alteration,or extension. Page 2
,•:,, Each additional inspection over allowable in any of the above
\na 1 Address: { `i i i �.(f�`lP y C?C tav�j,.\ 1 i',.r c'C.; '}-d Additional inspection(1 hr min) 66.25/lir
v — c• 2. Investigation(1 hr min) 66.25/hr
City/State/71P: "` lc Cc n' c\ ue ? } _ s' _
r
Fax: Industrial plant(1 hr min) 78.18/hr
OIIe:(�iCi't )c,3c) _ �i"j tU p (`>uS )7. �J�y I (,� / =Ins ions for which no fee is
J� L`� l� 90.CK1/hr I
MB Lie.: 19 27-1--' i Electrical Lie.: C(,,j(p. Suprv.Lie.: (-7)(p i 2 ' specifically listed('h hr min)
4 / ELECTRICAL PERMIT FEES
Suprv.Electrician signature,reyuired:�J i% Subtotal e=r'j, '- V
fi � Date: Plan review(25%of permit Ice).
Print name: l v�l:t i L� r�a�1< S�'l.� Y ICJ State surcharge(12%ol'perutit fcc): -1 , l L --
Authorized signature:
TOTAL PERMIT FEE: f
- f his permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
- • Number of inspections allowed per permit 4i
L\auildinglPennirS�Ct.0 Permu.4yp_L•l,R_[RF..A°c Rev USr21ldUt)
440-46150t 1, /COW FGa (/J� '