Permit CITY OF T GARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit-#: ELC2010 -00036
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 01/22/2010
1G ARfA " Parcel: 2S111BC00300
Jurisdiction: Tigard
Site address: 14415 SW 100TH AVE
Subdivision: TIGARDVILLE HEIGHTS Lot: 18
Project: Ornelas
Project Description: (2) branch circuits for furnace and a /c.
Owner: FEES
ORNELAS, STEVE Quantity Description Date Amount
14415 SW 100TH AVE
TIGARD, OR 97224 2 crt Branch Circuits 01/22/2010 $63.60
wo /Purchase Service or
PHONE: 503 - 598 -0558 Feeder •
1 ea 12% State Surcharge - 01/22/2010 $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. ATTEN Oregon aw requires you to .follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -00 through. OAR 952- 0 1 u may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issue By: Perm ittee Signature:
OWNER' INSTALLATION ONLY
The installation is being made on property l own which of intended for sale, lease'or rent.
OWNER'S SIGNATURE .11-P _�� 7 __ 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.
•
. on l y " F � win.. fi 3/ �'., �r"' F .1.15r 7.: o r O'd�l l 6 b "1� ?' ,I ' ' 714 i u�" '. ii
Ele r.><cal Permit Application ' �' ,
';" P ,1 w "i oFF
� i4„uS i .N = � ,1 a � I
Ili City of Tigard g pan Review
/ ® ;.l PermitNo.: 0 B �d3
13125 S W Hall Blvd., Tigard, OR 97223 .
Phone: 503.639.4171 Fax: 503.598.1960 ' Date/B : Other Permit: •
TIGARD' �
Inspection Line: 503.639.4175 Date Ready /By: Juris: ® See Page'2for .
Internet: www.tigard- or.gov Notified/Method: -/!a Supplemental'Inforination •
- TYPE =dOF WORK: - A _ P REVIEW
New construction /e
1 1,PAdditibn /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked•6elow) :'
❑ Service or feeder 400 amps or more ❑ Building over three stories:'
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
. '
CATEGORY OF r RUCTION ,; exceeds 10,000 amps•at 150 volts or ❑ Floating buildings. •
CONST
" less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
�Jl- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for alt otherinstallations. buildings.,
/❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
., ' ..: _ , _ . . . , - ❑ Emergency system. larger separately derived system.
-, -JOB SITE)INFORM N ATIO AND LOC
. .. �. =, _., .TI:,.. ,.. � ❑ Addition of new motor load of ❑ . .,,E < ,.1.3„
Job no.: Job site address: /9y/5- or more. occupancy.
/ y/� ' /� 1 (. �O 0 �� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ❑ Health : care facilities. ❑ Supply voltage for more,than
• ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: 0. /v L fj-S ❑ Service or feeder 600 amps or more.
FEE SCHEDULE -..,
Cross "street /directions to job site: nescripnou 1 Qty. 1 Fee. 1 Total. I "
New 'residential single - or multi - family dwelling unit.
Includesiattached garage.
Subdivision: Lot no.: 1,000sq. ft. or less 168.54 4
Eal.add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: energ mited residential
„ Y d
" (DESCRIPTION' O F WORK: . ,,Y , 'm Lt (with, above sq. ft:) 67.84 2
Limited multi - family
( z) /J A 'e " C /2 L u /7_5 /(J /4 /�'GC ,e, 41-C , _ 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 '- IV ,TENANT; ,r,• "' 201` amps to 400 amps' 133.56 2
Name: _5 TE7/E t RiJEr S 40L amps to 600 amps 200 2
601' amps to 1,000 amps 301.04 2
Address: /y`/ /.S S&) / p D b Over 1,000 amps or volts 552.26 2
City /State /ZIP: 77 f21j Q - / / p bz . �/ Temporary services or feeders installation, alteration, and /or
/ relocation
Phone: (503) ,5 ? f — Q 5"44) 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, re exchange, accor ng to ORS 447, 449, 670, and 701. 401 amps'to 599 amps 168.54 2
Owner signature: � Branch circuits: new, alteration, or extension, per panel
g ij02/ Date: 003/2010 A. Fee for branch,circuits with
^ ® &PPLICANT ; '❑: 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, /
56.18 �6 , /1 2
first branch circuit
Address: Each add'I branch circuit / 7.42 7,y2, 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each-'manufactured or modular 67:84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only . 67.84 2
E -mail: Pump or irrigation circle 67.84 2
- 4 i, 'CONTRACTOR . ... ,, 4 • :�' 4 p, . 1' '" Sign or outline lighting 67:84 2
w _
Signal circuit(s) or limited -
Business name: Q of AiL
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
ELECTRICALPERMIT'FEES ; 4
Suprv. Electrician signature, required: Subtotal: 4g , 4 0
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): 7 , 0
Authorized signature: • TOTAL PERMIT FEE: 7/ , ,,3
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
s . • Page .2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL;WORK: bNLY; a _,,
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:
TailVIMEKW 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
❑ Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
Li Medical
n Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective. Signaling
❑ Other.
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: \ Building \Permits\ELC- PermitApp.doc 10/01/09