Permit CITY OF TIGARD ELECTRICAL PERMIT
n
COMMUNITY DEVELOPMENT Permit #: ELC2009-00651
Date Issued: 12/09/2009
T [CARD; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1 S133AD15800
Jurisdiction: Tigard
Site address: 11241 SW SUMMER LAKE DR
Subdivision: Lot: 0
Project: Vhay
Project Description: (1) branch circuit for lights and dimmer.
Owner: FEES
VHAY, JOHN S & ANN E Quantity Description Date Amount
11241 SW SUMMER LAKE DR
TIGARD, OR 97223 1 crt Branch Circuits 12/09/2009 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 12/09/2009 $6.74
Electrical
Contractor:
RENTAL HOUSING MAINTENANCE SERVICES
INC
PO BOX 317
PHONE: 503 - 678 -2136
FAX:
Type of Use: SF
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 acc ce 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. A NTION: 0 gon law requires you to follow the rules adopted by the Oregon Utility Notification Ce . T ' :e rule/ are t forth in OAR
952 -00 -0010 through OAR 952-s • -0 00. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.2 • . •699 or/ 332.2
Issu d By: / 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 Da •:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' �J Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
" `E le c trical Permit Application i ,, ` r �r US L. c N� ,; A �; . r ', %1: :'
CI of Ti and Received � D, / Permit No.: �' A 957
11114 "� g Date/By: cve � g// /1..,Z VJ r�-C
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
.i.• I (A I i. Inspection Line: 503.639.4175 Date Ready /By: Juris: ® See Page 2 for
- ' .. Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction idition/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 ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Tess to ground, or exceeds 14,000 ❑ Commercial -use agricultural
$..., Land 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
El Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: / / 2 C/ � G �/ 100HP or more. occupancy.
` [' `71 �� v"���C /G �-�� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: \J . � / ❑ Service or feeder 600 amps or more.
// FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. 1 Total 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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
n ; /�7� f , / Limited energy, multi- family 67.84 2
�i NI I tJ e t<exp•,•V' , 'K1 E_c._- -" , � / r , D,� �- l residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
.1G /GL G' i 1.4 ( / • 1 - N
— s t _ '7S /� (701-1 200 amps or less 100.70 2
(k PROPERTY OWNER . ❑ TENANT 201 amps to 400 amps 133.56 2
Name: �� / �, 'I V4- 401 amps to 600 amps 200.34 2
V'�'^ �' J r ! " 601 amps to 1,000 amps 301.04 2
Address: / / (i� y a Vi / / _ Over 1,000 amps or volts 552.26 2
City /State /ZIP: Z r `t _
Temporary services or feeders installation, alteration, and /or
relocation
1 s or less 59.36 1 200 am
Phone: ( }�� � 2 -� 7 ®Q Fax: ( ) P
Owner installation: This installat . • is b ng made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, s • - .. ,acco- 6-` Date: `Z
• in' ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: /� '
/ c Branch circuits - new, alteration, or extension, per panel
'
A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PE S above service or feeder fee,
7.42 2
each circuit _
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, / 56.18 %. 2
first branch circuit
Address: Each add'l branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR • Sign or outline lighting 67.84 2
Business name: ,
ame: Signal circuits) or limited -
extension. Describe: Page 2 2
f ... L l.� r �� l i to /� . 1r�G 'ener panel, alteration, or
Address: p , �p 3.4117- 7
City /State /ZIP: 6 0 A. t . r ., a, g 702-0 Each additional inspection over allowable in any of the above
r Per inspection 66.25
Phone: (50 5) L _ ai alp I Fax: ( ) t Iltt Investigation per hour (I hr min) 66.25
CCB Lic.: 14� I Electrical Lic.: C 545 1 Suprv. Lic.: y -- Industrial plant per hour 78.18
✓ ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: -b (
Plan review (25% of permit fee): je7
Print name: Date: State surcharge (12% of permit fee): (p ' 7q
Authorized signature: TOTAL PERMIT FEE: tr a •9 a,
This 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.
I:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
1 COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
H Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\Building\Permits\ELC- PermitApp.doc 10/01/09
12/21/2009 MON 13:27 FAX 5036782138 2001/001
Electrical Permit Applicatio r�jJ CEIVrD FOR OFFICE USE ONLY . :
City of Tigard Date /By: L ¶ P No. no l� e ,• 5
, �" /
13125 SW Hall Blvd., Tigard, OR 97223 2 P lan Review /
0 DateBy:
Phone: 503.639.4171 Fax: 503.598.196W E C 2 1 2009 Other Permit:
Inspection Line: 503.639.4175 Date Ready /By: lung;. /'/ RI See Page 2 for
TIGARD Internet: www.tigard or.gov Notified/Method: ''t L Supplemental Information
■
.
CITY OF TIGARD p �,„ ,� �y
;` .. 1 - q: - /• J--� '' � . .ga . 11 s f? +j` x ,, i -V , -F.L KPIY IG. M 3. `� 7 { �. 7 -, r . t;
,i1 +�� r. 114 �i ' �» � •a_ "[`YPE OiF���79����.� #4� �'� � � � 1 : _. ' �'. ,_ .
❑ New construction J 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 ❑ Other: where the available fault current ❑ Marinas and boatyards.
: ''� ° a� tF n'a' r t (. d Q V � ii#0 0 110 3 1, k s 7 � 0-O exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
v. _ ,.v �w • •.r.�l.^ s . .. 3' , t' � �' ¢0 rl " " `"' s - ''- less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
0 Multi - family ❑Master builder ❑Other: ❑ fire pump ❑ Installation of 75 KVA or
s U ms - ❑ Emergency system. larger separately derived system.
." y` r ',OB `l!7 f QRI_ + QJ�T A A -NP. Ti....,. ' 5 s? Addition of new motor load of ❑ 'A ` L. 1-2 .. 1.3"
100HP or more. occupancy.
Joh no.: Job site address: ` ,/ ,(� r
\\ �, S SWm1r - h \-okb t • ['six or more residential units. ❑ Recreational vehicle parks.
City/ State/ZIP: �� 2 3 ❑ Health -care facilities. 0 Supply voltage for more than
I �� •� 2 ❑ Hazardous locations. 600 volts nominal
Suite/bldg no.: Project name: ❑ Service or feeder 600 amps or more.
T '" . f FEk. S. CREb131GFi r h ` rr
Cross street/directions to job site: Description R 1 Qn. 1 Fee. 1 Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: . 1,000 sq. ft. or less .11 168.54 _ • Ea. add'I 500 sq. 11. or portion ■ 33.92 1
Tax map /parcel no.: Limited energy, residential
#, ui ? 2 } s'ASrr 67.84 2
` f t m+ `f, �' (w ith a .. ft. .
G },..._ w 3 . 9r t, JpS PfiboQ , „_ ��,
Limited energy, multi- family IIIII 67.84 2
(1) Ceo rckytor. (a , • f i } residential (with above sq. fl.)
• n Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
:yi`>r G „,, 4a}� 'PROPIrRTI'f Nyo.R 2 { a+ ! ; ..:+ 1, .,T N°1 11 e r ' , M h„ mpS mps 133.56
.. M +�-. �- T , .. - 201 a to 400 a In
Name: J ,,� bl 401 amps to 600 amps 1111 200.34
f 601 amps to 1,000 amps 11.1 301.04 _
Address: Li r\ \ a r. & r - Over 1,000 amps or volts 552.26 _B
City/ State/ZIP: ' rN I c i . a- Temporary services or feeders installation, alteration, and /or
relocation
Phone: (i Li' ) �u _ 340 i Fax: ( ) 200 amps or less 111. 59.36 -0
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 1 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: ' Date: • • A. Fee for branch circuits with
h 1 ? fr PPTiltxs r A3ii� r „ }S�N 3''S ' Y above service or feeder fee,
each brunch circuit 7.42 2
Business nameZQ4 l � l e t �a, ,t e 4ille ; ( t,,clx Le c B. Fee for branch circuits 1 G
r � ,1 without service or feeder fee, 56.18 �G , /0 2
Contact name: ' r/ �F-V , G hilitit,HA first branch circuit
Address: 1kv0 , ' VI 5 i Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/State/ZIP: bfm60 q -1QZ0 Each manufactured or modular 67.84 2
1 dwelling, service and/or feeler
Phone: ( - ) L'1$ -a \ 3 1.0 Fax: : 6 f fl _,.. Reconnect only 67.84 2
E-mail: IL:' ry ' r c t & et IL-Pin }ax c t rS • COrte l Pump or irrigation circle 67.84 I 2
r s �' Q r. , .i.4 �; 1 ,, ` , ,, 1 4 r r f " - � i Si
�' -„ , =.,.in ,,. ,;c;,a - ,,_9,;..., :, C01!1,,,.. ,�QR (1. « > 5, a ...1.,?.7 . - :,„ „. , .:. , on or outline lighting 67.84 2
o
`` Signal circuits) or limited -
Businessname vn \ Aot.&s � C
t
. 'Q‘ t 4./ ti Lies energy panel, alteration, or
Address: -T ^� 31-1 extension. Describe: Page 2 2
\plat City /State/ZIP: ba,„ a\ G � -1
(/-cam Each additional inspection over allowable in any of the above
1 Per inspection 66,25
Phone: (S( ) ; -1 _ l , Fax: (S ) - a r nvestigation per hour (1 lu min) 66.25
!� Electrical Li
f r CCB Lic.:1U al c. Sup . Lic.: Industnalplant perhour 78 18
l0 p ��acJ 5
.�z 4� „(� r' -� �!�' �, ,P,p,�+IGI'Xf't�aFEF�5,, r f .' 1' ! z l � ib"
Subtotal:
Suprv. Electrician signature, required: /
t
/' Date: Plan review (25% of permit fee):
Print name: � r eq L;.. Vi � i 0,9169 State surcharge (12% of permit fee):
f
Authorized signature:' I TOTAL PERMIT FEE:
This 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.
I:\ Building \Permits\ELC- PetaitApp.doc 10/01/09 440- 4615T(IirosicOM/WEn