Permit T311054;0; CITY OF TIGARD ELECTRICAL PERMIT
?, COMMUNITY DEVELOPMENT Permit #: ELC2010 -00238
:TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/14/2010
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Parcel: 2S110BA09200
Jurisdiction: Tigard
Site address: 14127 SW 116TH TER
Subdivision: EVERGREEN SPRINGS Lot: 17
Project: Moss
Project Description: (1) branch circuit for outdoor outlet.
Owner: FEES
MOSS, JAMES A & Quantity Description Date Amount
KATHLEEN L, 14127 SW 116TH TER
TIGARD, OR 97224 1 crt Branch Circuits 05/14/2010 $56.18
wo /Purchase Service or
PHONE: 503- 624 -6027 Feeder
1 ea 12% State Surcharge - 05/14/2010 $6.74
Electrical
Contractor:
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports (Conditions)
This permit issued su. -- to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done accordance with a. •roved 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. ENTION: Oregon law equir- you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 0010 thr.ugh OAR 952-001-010 Y. m- .tain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.233444_.g,�j{
Issued a : /� Permittee Signature: Y
\ 04 //
OWNER INSTALLATION ONLY
The installation is being made on property I n which is t intended f sale, lea e or rent.
OWNER'S SIGNATURE Date: 5 `t / 0
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.
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Electrical Permit Application �, �� t, k l OR OI I I(I 1i51 'NO 1, ,11% � o'� ° „� ' 1
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j , Received ..--/H �it' Permit No.: p
City of 'Tigard DateB : � G� ...A.; o - co d o? z
1111 ° 1 3125 SW Hall Blvd., Tigard, OR 97223 Plan Review
;2 ' Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
l ' Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
I Il \,1('11 Internet: www.tigard - or.gov 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
❑ 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.
/ El Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: ptigy !W `c, rn r,, am, Six or more occupancy.
r7 e ❑ Six or morre e r rest esidential units. ❑ Recreational vehicle parks.
City /State /ZiP: 7 ,--, & J oR e1 7 C.. ❑ Health -care facilities. ❑ Supply voltage for more than
1 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: !.5 ❑ Service or feeder 600 amps or more.
7 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'I 500 sq. 0 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
gl e✓!Ga-%b d- ot"t / d ! e residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
D `PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Q ` y( 7 /� 601 amps to 1,000 amps 301.04 2
Address: /o`g !�/ /4 70 7j^�� oe Over 1,000 amps or volts 552.26 2
6 Temporary services or feeders installation, alteration, and /or
City/State/ZIP: `; pQ ./vA ax- c 7 Z' relocation
Phone: (5j/) rio•Z i / Z"7 Fax: ( ) 200 amps or less 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 ent, or e ha a according to ORS 447, 449, 670, and 01. 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
- - -- - above service or feeder fee
0 •
PPLiCA 1 ❑CONTACT PERSON 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 f �
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
ty 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: panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: ) /6 — Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: 00 investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (' /A hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT 'FEES. C
Suprv. Electrician signature, required: Subtotal: 'jlj • j
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): - 7�{1
TOTAL PERMIT FEE: (o r G '
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.
N umber of inspections allowed per permit.
I1Building \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*
H Burglar Alarm
n 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:
❑ A udio and Stereo Systems
n Boiler Controls
n C • lock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
I - 1 I ntercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\3uilding'Permits\ELC- PermitApp.doc 10/01/09