Permit ' CITY OF TIGARD ELECTRICAL PERMIT
r q
` f. a COMMUNITY DEVELOPMENT Permit #: ELC2009 -00581
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 10/29/2009
Parcel: 2S111 BD03800
Jurisdiction: Tigard
Site address: 9846 SW PEPPERTREE LN
Subdivision: Lot: 0
Project: Goodhead
Project Description: Add /alter (4) branch circuits.
Owner: FEES
GOODHEAD, DAVID Quantity Description Date Amount
9846 SW PEPPERTREE LN
TIGARD, OR 97224 4 crt Branch Circuits 10/29/2009 $78.44
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/29/2009 $9.41
Electrical
Contractor:
ALLIED ELECTRIC
PO BOX 1640
NORTH PLAINS, OR 97133
PHONE: 503- 614 -8000
FAX: 503 - 614 -1186
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $87.85
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 e the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set . •rth 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 1.800 .2344.
Issued By: VAYQUIV lit' 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' Date:
LICENSE NO.
Cali 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.
littg: ^'t O `aT IJS -III'"w " vi- 4 "
Electrical Permit Application � q,e to al olt l 1 , .oN L w it , i
I 1 ' , Received I
City Tigard —
�
h' g OCT 2 Ziit Date: - J Permit No.: Ill 13125 SW Hall Blvd., Tigard, OR 97223 � d Plan Review
Phone: 503.639.4171 Fax: 503.598.1' . t DateBy: Other Permit:
1 C A it Il' Inspection Line: 503.639.4175 Vt. fit �t ' � n ` ■ Date Ready /By: 1 ® See Page 2 for
S >bi..aY Internet: www.tigard or.gov 101 I �` 1 `� j� Notified/Method• G Supplemental Information
• TYPE - OF WORK 1 111 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
K1- 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: 9846 SW Peppertree Ln or more occupancy.
Six
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, OR 97224 ❑ Healthcare 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: Last house in Cul de SaC Description 1 Qty. 1 Fee. 1 Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
Outdoor cooking area and relocate spa Limited energy, multifamily 67.84 2
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
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: ( ) 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
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,
each branch circuit 3 7.42 22 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 1 56.1 56.18 2
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
1 � Signal circuit(s) or limited -
Business name: �i � �lr L energy panel, alteration, or
Address: PC X• IP40 extension. Describe: Page 2 2
City /State /ZIP: 4 19 nt_ faae p 0 � � "7� 2 0 Each additional inspection over allowable in any of the above
/
Phone: ( ) 61st( — Pp?) Fax: ( ) 6/4( —144 Per inspection 66.25
Investigation per hour (1 hr min) 66.25
CCB Lic.: 3 $ 5 3 5 Electrical Lic.: 3t/ /11 L Suprv. Lic.: 3 g 5'5 Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, requireP t. j.,i-e4-1,--- ,� Subtotal 78.44
Print name: iLN��� ,` i l f <(- Date: Plan review (25% of permit fee):
� J� State surcharge (12% of permit fee): 9.41
Authorized signature: TOTAL PERMIT FEE: 87 .85
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.
1:\ Building \ Permits \ELC- PermitApp.doc 10/01/09 440- 46t5T(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:
Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
0 Vacuum Systems*
0 Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
• Instrumentation
n Intercom and Paging Systems
• Landscape Irrigation Control*
O Medical
n Nurse Calls
n Outdoor Landscape Lighting*
O Protective Signaling
O Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
IABuilding\Permits\ELC-PermitApp.doc 10/01/09