Permit ELECTRICAL PERMIT
v CITY OF TIGARD
m COMMUNITY DEVELOPMENT Permit #: ELC2010 -00137
1.T I G11 RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/24/2010
Parcel: 2S102DB08300
Jurisdiction: Tigard
Site address: 9136 SW HILL ST
Subdivision: Lot: 0
Project: Jamal
Project Description: (1) branch circuit for a/c installation.
Owner: FEES
JAMAL, MOUSSA AL Quantity Description Date Amount
9136 SW HILL ST 1 crt Branch Circuits 03/24/2010 $56.18
TIGARD, OR 97223 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 03/24/2010 $6.74
Electrical
Contractor:
WESTERN CASCADE ELECTRIC INC
8900 SW BURNHAM ST E18
TIGARD, OR 97223
PHONE: 503 - 521 -0000
FAX: 503 - 620 -5430
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 cordance wi - .proved .fans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. TENTION: Oregon la r you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 01 -0010 th ough OAR 952 -00 Q1 100. Yo - ay obtain a co y of the rules or direct questions to OUNC by calling 503.246.669• 1.800.332.2344.
sued By: as Permittee Signature: NW 41
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' `u = 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.
Electrical Permit Application FOR OFFICE USE ONLY
Received p
. City of Tigard Date /By: r . p Z j /O Permit No.: /j�D 00/'37
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �'"
Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Pennit:
T 1 G A R D 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 E 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
® I- 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 ", '1 -2 ", "I -3 ",
Job no.: Job site address: / C 11� �) IOOHP or more. occupancy.
W �] V� . /7r i ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard Oregon 97223 ❑ 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 SCIIEDULE
Cross street/directions to job site:0 m CIl I' S wit n a N Kai) Description 1 Qty. I Fee. 1 Total 1 *
New residential single- or multi - family dwelling unit.
IAN -+ c t\ o nf\ rR f 0 , /) oft ' ?Nil h, ) I -St , Includes attached garage.
Subdivision: L 1 1 Lot no.: 1,000 sq. 11. 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.)
Limited energy, multi - family 67.84 2
A/C installation residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 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 less 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps to aoo amps I25.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
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 1 56.18 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each or modular
City /State /ZIP: dwelling, service manufactured and/or feeder
67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E Sign or outline lighting 67.84
2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Western Cascade Electric panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 8900 SW Burnham St E 18 Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Tigard Oregon 97223 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 521 - 0000 Fax: (503) 620 - 5430 Inspections for which no fee is 90.00 / hr
specifically listed (%: hr min)
CCB Lic.: 153416 Electrical Lic. 4 -616C Suprv. Lic.: 4625 -S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: t . < Subtotal: 56.18
Plan review (25% of permit fee):
Print name: Jeff Evans Date: 3/23/10 State surcharge (12% of permit fee): 6.74
-- TOTAL PERMIT FEE: 62.92
Authorized signature: ______...---- This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Jeff Evan Date: 3/23/10 • Number of inspections allowed per permit.
l\ Building \ Permits \ELC - PermitApp.doc 10/01/09 440-4615T( 11/05/C0151/WEB