Permit U. CITY OF TIGARD ELECTRICAL PERMIT
,r q
,a COMMUNITY DEVELOPMENT Permit #: ELC2010 00026
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/19/2010
Parcel: 2S114AB00400
Jurisdiction: Tigard
Site address: 9290 SWDURHAM RD
Subdivision:' Lot: 0
Project: Strothers
Project Description: (2) branch 'circuits for new furnace.
Owner: FEES
STROTHERS, HARRIET A Quantity Description Date Amount
9290 SW DURHAM RD
PORTLAND, OR 97224 2 crt Branch Circuits 01/19/2010 $63.60
wo /Purchase Service or
PHONE: 818 - 203 -0658 Feeder
1 ea 12% State Surcharge - 01/19/2010 $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, 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 rough OA' • 2 -0 0101 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1 :00 .3 4 , 34
Issue. By: i 1 _' i 1 L-- Per mittee Signature: :� ~
OWNER INSTALLATION'ONLY
/
The installation is being made on propert : w is49 ' lende1 for sale, lease or rent. •
OWNER'S SIGNATURE
���/r ` — Date: / — / —0
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 ,,;` ,4, ° m h 'n, FOR oi- rlcl o il Ei i ° ,' ,.ailu;,' t 4°i „, r
City Of Tigard Received 1 / f /D �IJ . Permit No.: ( �Q,46,
Date/B
°- 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
13 Phone: 503.639.4171 Fax: 503.59811960 Date/B' :. Other Permit:
.1.1G A It 1) Inspection Line: 503.639.4175 Date Ready/By: Juris: . ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental,tnformafion
” • • TYP OF WORK • " • • ' PLANREVIEW
❑ New construction ❑ Addition /alteration/replacement Please check :all that apply (submit 2 sets of plans w /items checked below):
❑Serviceior feeder 400 amps or,more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CA OF"CONS1'RUCTION . '' exceeds 10,000 ampsat,I50 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: 0 Fire pump. ❑:Installation of 75 KVA or
JOB SITE INFORDIATION AND LOCATION ❑ Emergency system. larger separately derived system.
_ ❑ Addition of new motor load of ❑ "A ", "E , `1'_ -2 ", "1 -3 ";
Job no.: Job site address: 7 Z.7 0 Sj, ,a ✓tip & 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tic, .p . rt. b 01Z 9 Z2 4. ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: 0 % ❑ Service or feeder 600 amps or more:
. .. FEE 'SCHEDULE • • ,
Cross street/directions to job site: Description 1 Qty. 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
Tax map /parcel no.: Ea. add'1 500 sq. ft. or portion 33.92 1 • Limited energy, residential 67 84 2
•,DESCR_IPT_I_ON'O_ F WORK. ` : • _ (withabovesq. ft.)
/ Limited energy, multi- family 67.84 2
1GOtn-v ,' `ICiA-1 -f' { ✓vte...c L.. residential (with above ,sq. ft)
` Services or feeders installation, alteration, and/or relocation
N � u1 KiLt r ` F n _ L T
'f
• 7) b ett_A v C 200 amps or less 100.70 2
` ►�
`" III - PROPERTY OWNER' , -, . ❑ . TENANT , _ . 201 amps to 400 amps 133.56 2
I (mi
Name: l v. A5
401 amps to 600 amps 200.34 2
�
1 �� 601 amps to 1,000 amps 301.04 2
Address: 1't a S1n-1 'IA-v- (A- s_.- - ' Over 1,000 amps or volts 552.26 2
City /State /ZIP: 1 — t A'R.1 Olt q — Z,ZI' Temporary services or feeders installation, alteration, and /or
■ relocation
Phone: (2 I b ) 20 b U s - e 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 • c ange, ccording to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits new, alteration, or extension, per panel
Owner signatur AM,. Date /., / f / a
A. Fee for branch circuits with
-❑ APPLI 4fir .❑ - CONTACT 'PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, ( 56.18 2
first branch circuit
Address: Each add'I.branch circuit 1 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: ( ) I Fax: : ( ) Reconnect only 67:84 2
E -mail: • Pump or irrigation circle 67.84 2
' ;` CONTRACT_O_ R , ' - • . Sign or outline lighting 67.84 2
Business name: Signal circuit(s) or limited -
energy Pa, 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: ( ) I Fax: ( )
Investigation per hour (1 hr min) 66.25
CCB Lic.: 1 Electrical Lic.: I Suprv. Lic.: Industrial plant per hour 78.18
:ELECTRICALJPERMIT FEES_ '
Suprv. Electrician signature, required: Subtotal: 63 Lev
Print name: Date:
Plan review (25% of permit fee): -a— •
/ State surcharge (12% of permit fee): 7 eo 5
Authorized signatur•. ; / -•: o r "' TOTAL PERMIT FEE: -7 A3
'/ This permit application expires if a permit is not obtaitted within 180
Print name: Li yiG,4 S /� j � Date: days after it has been accepted as complete.
7 * Number of inspections allowed per permit.
I: \ Building \Permits,ELC- PermitApp.do 10/01/09 440 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
( RESIDENTIALWORK°ONLYs
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ 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
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*Noiicenses are required. Licenses are required
for all'other 'installations
1: \ Building \Permits\ELC- PermitApp.doc 10/01/09