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Permit 3 CITY OF TIGARD ELECTRICAL PERMIT Y t q ; 0 COMMUNITY DEVELOPMENT Permit #: ELC2009 -00558 Date Issued: 10/21/2009 T[GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S133DD00700 .,x., ...ter. Jurisdiction: Tigard Site address: 11689 SW 129TH PL Subdivision: VILLAGE AT SUMMER LAKE PARK 2 Lot: 46 Project: Barbu Project Description: Alter (2) branch circuits for 2 new bathrooms. ADDED (1) 200 amp or less sub panel to scope of work. Owner: FEES BARBU, DAN Quantity Description Date Amount 11689 SW 129TH PL TIGARD, OR 97223 1 ea Services or Feeders - 200 03/03/2010 $100.70 amps or Tess PHONE: 2 crt Branch Circuits w /Purchase 03/03/2010 $14.84 Service or Feeder 1 ea 12% State Surcharge - 03/03/2010 $13.86 Contractor: Electrical OWNER PHONE: FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $129.40 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 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 the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 throt QPR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: � 01.k V� CJ1�.X /1,3 Permittee Signature: Q Q "5 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. ' � ��1 CITY OF TIGARD ELECTRICAL PERMIT C ' :' .t, COMMUNITY DEVELOPMENT Permit #: ELC2009-00558 .rz ' Date Issued: 10/21/2009 TIGARD; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S133DD00700 Jurisdiction: Tigard Site address: 11689 SW 129TH PL Subdivision: VILLAGE AT SUMMER LAKE PARK 2 Lot: 46 Project: Barbu Project Description: Alter (2) branch circuits for 2 new bathrooms. Owner: FEES BARBU, DAN Quantity Description Date Amount 11689 SW 129TH PL TIGARD, OR 97223 2 crt Branch Circuits 10/21/2009 $63.60 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 10/21/2009 $7.63 Electrical Contractor: OWNER PHONE: FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $71.23 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 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 the rules adopted by the Oregon Utility Notification Center. ose rules are set forth in OAR 952 -001 -0010 through OAR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or . 0. 3�4. Issued By: ' `olt .�,i itv Permittee Signature: l� 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. Electrical Permit Application ,:. - . , `N . I n R I i ICF. S O NO p C��VE City of Tigard IIi ' eceived �t 1 \ ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ����CCCJJJ t c 7 'PIA Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Permit No.: E( c 7 0 09. , 0' 'N,8 OCT T 2 1 2009 Date/By: Other Permit: rticnlr D ,i, 5 Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Suiti Internet: www.tigard- or.gov CITY OFTIGA Notified/Method: `Clel Supplemental Information TYPE OF WORflUILDING DIVISION PLAN REVIEW ❑ New construction NI 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 [gl 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 Toad of ❑ "A ", "E ", "I -2 ", "1 -3 ", 100HP or more. occupancy. Job no.: Job site address: ��6� 19 9 £ / /27e4 pi. ❑ Six or more residential units. ❑ Recreational vehicle parks. • City/State /ZIP: /7 2 ' , '' , ©Q 9722 3 ❑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. 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. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential • DESCRIPTION. OF WORK - (with above sq. ft.) 67.84 2 ss �// + l 1 Limited energy, multi - family "t o ri K owe er c i one ocbava{'T .A t1 OR a residential (with above sq. H.) 67.84 2 ? aun/ pipe (�OG17u( - s wi 4 /6r rorh 0/ ?Iwo h ?/ 1bS4 . Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ' ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 • Name: 0 0644 U 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: /16479 S /29 n Over 1,000 amps or volts 552.26 2 City /State /ZIP: o / e/ ae 917223 Temporary services or feeders installation, alteration, and /or / / relocation Phone: (5p3) -7 7_5,12,6 Fax: (50 6) -37Z - 578I/ 200 amps or less 59.36 1 Owner installation: This installation is ing made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exch rding to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: /49 Branch circuits - new, alteration, or extension, per panel �Ot19 A. Fee for branch circuits with ' ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, 4 56.18 2 first branch circuit Address: Each add'I 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: Signal circuit(s) or limited - energy panel, alteration, or Address: extension. Describe: Page 2 2 City /State /ZIP: Each additional inspection over allowable in any of the above Per inspection 66.25 Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 66.25 CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 78.18 ELECTRICAL PERMIT FEES . Suprv. Electrician signature, required: Subtotal: Print name: Date: Plan review (25% of permit fee): State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: 7 ) . 23 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* n Burglar Alarm n Garage Door Opener* ❑ 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: ❑ Audio and Stereo Systems •. n B • oiler Controls • n Clock Systems ".. . n D • ata Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ 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 C\ Building \Permits\ELC- PermitApp.doc 10/01/09 Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or Y . I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and 1 hereby certify that the information on this homeowner statement is true and accurate. And /3/MA Print Name of Pe it Applicant /0 f /fie 9 Signature of Permit Applicant Date Permit #: ,//64 3 W 2 j J 9 ?Lace Address: •��� 77,0 , OA 97223 Issued by: Date: This Copy for Permit Offices