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Permit CITY OF TIGARD ELECTRICAL PERMIT x `�A O ;o COMMUNITY DEVELOPMENT Permit #: ELC2010 -00140 ro Date Issued: 03/26/2010 41 GA RD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S135DC01100 Jurisdiction: Tigard Site address: 11865 SW LINCOLN AVE Subdivision: Lot: 0 Project: Blunt Project Description: Owner: FEES BLUNT, ROBERT Quantity Description Date Amount 11865 SW LINCOLN AVE TIGARD, OR 97223 2 ea Investigation Per Hour (1 hr 03/26/2010 $132.50 min) PHONE: 971- 222 -5355 1 ea 12% State Surcharge - 03/26/2010 $15.90 Electrical 1 hr Hourly Electrical Rate 03/26/2010 $90.00 Contractor: 1 ea Hourly Electrical 12% 03/26/2010 $10.80 SIBCO ELECTRIC Surcharge PO BOX 466 SALEM, OR 97306 PHONE: 503 - 932 -5648 FAX: 503- 399 -1305 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $249.20 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. - be done in accordance with approved plans. This permit will expire if work is not started within 180 days of iss - e, or ork is suspended • more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifi - '•n Cen - r. ' ose rules - - forth in OAR 952 - 001 -0010 thr• gh OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 13.24• : or ;0,2.234- 0. Issued By: \ ■ MI . _ L ! -` r i A , Permittee Signature: / ' '.eLA AL`'1 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 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. a f ,,I , t.i ,/ i ' % ` , �F r ry "''v x ry p5 7 +ac V � d u � : : Electrical Permit Application - ' w z 5- f k' ' . 1 O < 1(_1 <l7til ()i \'I 1 ` s �^ 1x t r a MAR � , a . - . a -40e.' • . ,,w• e ,_ 1>tl iti rn+ iqt. n� ia, . m : �,,,.e. nii:a i a 'y1H Received - . City of Tigard 6 2010 ► Permit No.: E 10.2C 40 lig 131 SW Hall Blvd., Tigard, OR 9722:x1 D ate/By: ® g ' �9 Plan Review ' C Other Permit: P hone: 503.639.4171 Fax: 503.598 o i (}�'�r Dat e/By: Inspection Line: 503.639.4175 DUOC ! _ C7 Date Ready /By: I ® See Page 2 for I Il A'IZ Internet: www.tigard- or.gov V � ''� LiiV1 1 'j •fi Notified/Method: I- i Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction jgr 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 Igr 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 ", "I -3 ", L �Cc/ Six or or more more. R occupancy. Recreational Job no.: Job site address: /465L5-6..) p /� V e ❑ Six or more residential units. ❑Receational vehicle parks. City /State /ZIP: / v.-07 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: Ro Ue // i/4"h7i ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description 1 Qty. 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 168.54 4 Ea. add') 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.) l Limited energy, multi - family 67.84 2 /e y , I ^ ler / 1 y � G �P residential (with above sq. 11.) / e /7`p Services or feeders installation, alteration, and/or relocation 000,4 G O4��.✓ /e 200 amps or Tess 100.70 2 ❑ PROPERTY OWNER ` • ❑ T ENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and /or City /State /ZIP: relocation Phone: ( ) 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 1 own which is not intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with • ❑ APPLICANT ❑ 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: /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: � ibeo �/ l/C panel, alteration, or extension. Page 2 2 ///'' Each additional inspection over allowable in any of the above Address: Pt 00, x ,6.6 Additional inspection (1 hr min) 66.25/ hr City /State /ZIP:�� /ej. an Z3©�' Investigation (1 hr min) 66.25/ hr 132 Industrial plant (1 hr min) 78.18/ hr Phone: (33) e32 s(' 443 Fax: ( ) 393 l 30S Inspections for which no fee is ' 90.00 / hr go specifically listed (%3 hr min) CCB Lic.:'5qSIs Electrical Lic.: 24 -S1yC Suprv. Lic.: � �355 ELECTRICAL-PERMIT FEES ' IS Suprv. Electrician signature, required: permit Subtotal: fee): e Z 2 Plan review (25% of Print name: .�0 h � Ch rl � e nLse� Date: 3 1 2 " State surcharge (12% of permit fee): 2 ( , �c' 31210 TOTAL PERMIT FEE: t?y9 20 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: * Number of inspections allowed per permit. I:\Building\Permits\ELC - PermitApp.doc 10/01/09 440- 4615T( I I /05 /CO61/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: H Audio and Stereo Systems* ❑ Burglar Alarm H Garage Door Opener* n Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* n Other: COMMERCIAL WORK ONLY: Fee for each commercial $67.84 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: H Audio and Stereo Systems n Boiler Controls ❑ Clock Systems H Data Telecommunication Installation ❑ Fire Alarm Installation H HVAC ❑ Instrumentation H Intercom and Paging Systems ❑ Landscape 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