Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00091
Date Issued: 02/24/2010
T 1 G D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S114BCO3800
Jurisdiction: Tigard
Site address: 10372 SW BONANZA WAY
Subdivision: RIVERVIEW ESTATES NO. 2 Lot: 75
Project: Thomas
Project Description: Add /alter (2) branch circuits for move washer and dryer.
Owner: FEES
THOMAS, LORI Quantity Description Date Amount
10372 SW BONANZA WAY
TIGARD, OR 97224 2 crt Branch Circuits 02/24/2010 $63.60
wo /Purchase Service or
PHONE: 503- 443 -6018 Feeder
1 ea 12% State Surcharge - 02/24/2010 $7.63
Electrical
Contractor:
APOLLO ELECTRIC
PO BOX 80783
PORTLAND, OR 97286
PHONE: 503 - 244 -4410
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. Those rules are set forth in OAR
952- 001 -0010 thr ugh OAR 952 001 -0100. You r may yo obtain acopy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
6l J
Issued By: I .Cf\Q Perm ittee 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 Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' 1 1 / ✓ �� Date:
LICENSE NO. 35
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.
� p •
) ' '` - '� z'� �'•.. -t i`;t(l < ��r '�3�1V� ��s r£�1 i
Electrical Permit Application -- ' ..;: '. I O lt 01 I ICE IJS )NIA � j 1 pv , ,.
City g FEB 2.4 2010 Receive
1,11 Ci of Tigard ) Permit No.: f D ate/B : I , • . COM
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review `
I'IGr \ILO P �I �� Ready/By: ;: ! Phone: 503.639.4171 Fax: 503.598.196 .l ����� Date/B : Other Permit:
Inspection Line: 503.639.4175 Date Read Page 2 for
f�^ Y El See Pa g
. ,: = Internet: www.tigard- or.gov BUILDING DIVISIC. ? 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.
['Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: o 3 7Z 3C0 121,7 100HP or more occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: p/�,o�i .977-.977-k/ � ❑ Health-care a Hazardous fcation . ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
t e J /63 FEE SCHEDULE t Qty. Cross street/directions to job site: rit', / a, y Description Fee. l 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. R. 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
l � j '
PS ' Py&V e) y 4LI residential (with above sq. ft.)
67.84 2
_ •� 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
401 amps to 600 amps 200.34 2
Name: /or) r77yriRS' 601 amps to 1,000 amps 301.04 2
Address: /0372 72, C e( ,/ , ''2" z 4 ` I,�� ' _ I Over 1,000 amps or volts 552.26 2
`J " J I Temporary services or feeders installation, alteration, and /or
City /State /ZiP: ra h 0 (1?--- relocation
Phone: Cab ) e4 F"' 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 1 own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
�LAPPLICANT ; 1:1 CONTACT PERSON • above service or feeder fee 7.42 2
each branch circuit
Business name: — Av e) /6 F /re jj� C B. Fee for branch circuits without
p� service or feeder fee, first x 56.18 2
Contact name: /i r , ,c
o ;' branch circuit .. /�'' Each add'I branch circuit X 7.42 2
Address: O Miscellaneous (service or feeder not included)
City/State/ZIP: i :7/2 I t� 0/2_ 9, 7' 7ro Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (C.03) Z,4/ 04/. Fax: : (5' Z!/l/ -
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: n /` �/s�� f 1. panel, alteration, or extension. Page 2 2
�`-' C Each additional inspection over allowable in any of the above
Address: / Bo v ge) 7/3 Additional inspection (1 hr min) 66.25/ hr
�
l Investigation (1 hr min) 66.25/ hr
City /State /ZiP: Fbill, i2d 0z el T6 v Industrial plant (1 hr min) 78.18/ hr
Phone: ( .. 0 ) V-'K��e3 Fax: (c r ' ) 24 >1 i L �i 6 Inspections for which no fee is
3 L. � specifically listed (/z hr min) 90.00 / hr
CCB Lic./ p'310 Electrical Lic.:39,„ Suprv. Lic.: 4 223.5 ELECTRICAL "PERMIT FEES •
�� -�� Subtotal:
Suprv. Electrician signature, required: ,s0 �
Plan review (25% of permit fee):
Print name: �c $ ` ll;� Date: 2,, 7 vL/ ) State surcharge (12% of permit fee):
~' i � / S � TOTAL PERMIT FEE: 7 l . a9-, ed Slgsignature: ���� This permit application expires if a permit is not obtained within 180
Print name: K me: ` � � )�� ,,,jr Date: 2 ✓�. days after has been accepted as complete.
Print
C � / N um b er of inspections a llowed 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*
❑ Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
H 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
H Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
H HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
H Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: ' Building \Permits PermitApp.doc 10/01/09