Permit CITY OF TIGARD ELECTRICAL PERMIT
Ir
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00086
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T I G ARL? 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 02/19/2010
Parcel: 1S134AD06800
Jurisdiction: Tigard
Site address: 10562 SW WINDSOR PL
Subdivision: Lot: 0
Project: Warren
Project Description: Add /alter (3) branch circuits.
Owner: FEES
WARREN, ROBERT Quantity Description Date Amount
10562 SW WINDSOR PL
TIGARD, OR 97223 3 crt Branch Circuits 02/19/2010 $71.02
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 02/19/2010 $8.52
Electrical
Contractor:
FRAHLER ELECTRIC CO
11860 SW GREENBURG RD
TIGARD, OR 97223
PHONE: 503 - 639 -4627
FAX: 503 - 639 -4673
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $79.54
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 t oug AR 952-001-0100. You You maa`y obtain ( a � copy of of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Sj)� QiL f u! c 7�1� '/— Permittee 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' 0 N\e/'�
r , 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 ., FOR OFFICE USE ONLY
City Of d T 1 an Received
Tigard FEB 1 201 Date/B: Permit No. `020 ....
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N. e 13125 SW Hall Blvd., Tigard, OR 97223 P lan Review
• Phone: 503.639.4171 Fax: 503.598.1960 ,• v _ ' ; - Date /B : Other Permit:
Inspection Line: 503.639.4175 ',4!! ' °' .' , ''� i
TIGARD
p s , r} l; ate Ready /By: El See Page 2 for
Internet: www.tigard- or.gov ' ' !.. '' \ : o- . ; ,.� +I-.3 t otified/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 El Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: El 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 - ", "I -.i ",
100HP or more. occupancy.
.lob no.: 67336 Job site address: 10562 SW WINDSOR PLACE ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ❑ Health -care facilities.
0 Supply voltage for more than
TIGARD, OR 97223 ❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: WARREN RESIDENCE ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description p 1 Otv. 1 Fee. I 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.)
Limited energy, multi - family 67.84 2
OD :O hi k II: '10101 Lap ■ fl ■ . residential (with above sq. ft.)
- 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: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( _ ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT 1 ❑ 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. 1 56.18 56.18 2
first branch circuit
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Address: Each add'I branch circuit 9 7.42 14.84 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
67.84 2
dwelling, service and /or feeder
Phone: ( ) I 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: . . an: Sign circuit(s) or limited -
1 Di: I• M. S ut t i ener panel, alteration, or
Address: 11860 SW GREENBURG ROAD extension. Describe: Page 2 2
City /State /ZIP: TIGARD, OR 97223 Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (503 ) 639 -4627 Fax: 603 ) 639 -4673 Investigation per hour (1 hr min) 66.25
CCB Lic.: 37410 Electrical Lic.: 34 -1 C Suprv. Lic.: 5110S Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required :7;0r / Subtotal: 71.02
Print name: Date: Plan review (25% of permit fee):
ADAM FTHER INGTON 02/11/10 State surcharge (12% of permit fee): 8.52
Authorized signature: TOTAL PERMIT FEE: 7q- 94
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections allowed per permit.
1\ Building \ Permits \ELC- PermitApp.doc 10/01/09 440- 4615T( 1 I /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:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ 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
❑ Boiler Controls .
E Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
E Instrrumcntation
❑ Intercom and Paging Systems
H Landscape Irrigation Control*
❑ Medical
H 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
I; buildin \Permit \ELC- PennitApp.doc 10/01/09