Permit "' CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
7
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IS COMMUNITY DEVELOPMENT Permit #: ELR2010 -00079
T I G ART 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 05/07/2010
Parcel: 2S 114AD04000
Jurisdiction: Tigard
Site address: 16633 SW 90TH PL
Subdivision: WAVERLY ESTATES Lot: 39
Project: Borosund
Project Description: Installation of audio and sterio.
Owner: FEES
BOROSUND, JEFFREY STEVEN Description Date Amount
16633 SW 99TH PL Restricted Energy Permit 05/07/2010 $67.84
TIGARD, OR 97224 12% State Surcharge - Electrical 05/07/2010 $8.14
PHONE:
Contractor:
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT
Total Number of Systems:
Audio & Stereo: y
Security Alarm: N
Garage Door Opener: N
HVAC: N Total $75.98
Vacuum System: N Required Items and Reports (Conditions)
Other: N
Other Desc:
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 t e_ru - adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OA' • 2- 001 -0100. • • - • - ., opy of the rules • direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B - �f / r , �
i _ r i�� 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 •cr Y� f \. Date: ) 7 I ) c,
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
CaII 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.
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Electrical Permit ADAM
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City of Tigard - 7 2010
Date Received _
'! t
lig ... ' C' Date/By: 5/ IU /577-- Permit No.: f_La2�jlo--00u72
1 3125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 FR _ Other Permit:
:9 � D Date/By: 1TaUl0 ...-- cx
0 . )(;), • I1 E A IL ' Inspection Line: 503.63 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard �,DIN�1 DIVISION Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New 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 ❑ 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
0 .1- and 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: ((�� -- S c
‘) 100HP or more. occupancy.
' l>�- � 0 Six or more residential units. 0 Recreational vehicle parks.
City /State /ZIP:
71- \ Q_ cy 7 Z ❑ Health -care facilities. ❑ Supply voltage for more 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: Description 1 Qtv. I Fee. 1 Total 1 "
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. fl. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
(with above sq. 67.84 2
DESCRIPTION OF WORK ( q• ft. )
Limited energy, multi - family 67.84 2
residential (with above sq. 11.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
ca. PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: ` � t a��'.��
-- S 601 amps to 1,000 amps 301.04 2
Address: l t 3 S \ >,- ' P I Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: c� �3 G� � 2Z� relocation
Phone: ( 5-7-7 , fr,25:, 3 t ? ( Fax: ( ) 200 amps or Tess 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchang according to ORS 447, 449, 670 an 701. 401 amps to 599 amps 168.54 2
�
7 �� .1 p Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: , A. Fee for branch circuits with
. 0 AP Lk NT I ❑ CONTACT. PERSON . above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67 84 2
y dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 _
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
•CONTRACTOR Signal circuit(s) or limited-energy
Business name: O Gt/l‘i 2 panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed (V: hr min) 90.00 / hr
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT .FEES
Subtotal: / 7 , a
Suprv. Electrician signature, required: / y
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): r ' , f /
TOTAL PERMIT FEE: 95, ? f p
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number o 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:
j RESIDENTIAL,WORK ONLY: ___ _ . •
Fee for all residential systems combined .. $67.84
Check Type of Work Involved:
Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
r COMMERCIAL WORK ONLY: ',
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n A • udio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n I • nstrumentation
❑ Intercom and Paging Systems
n L • andscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ 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