Permit 'i %^ ELECTRICAL PERMIT
. '
CITY OF TIGARD
t is -. COMMUNITY DEVELOPMENT Permit #: ELC2010 -00356
- Date Issued: 07/14/2010
TiGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1 S 125DC06500
Jurisdiction: Tigard
Site address: 9670 SW SHADY PL
Subdivision: ASH CREEK GATES Lot: 7
Project: Gilbert
Project Description: (1) feeder and (3) branch circuits for pool.
Owner: FEES
GILBERT, JOEL S & MARSHA I Quantity Description Date Amount
4802 SW SCHOLLS FERRY RD STE C
PORTLAND, OR 97225 1 ea Services or Feeders - 200 07/14/2010 $100.70
amps or less
PHONE: 3 crt Branch Circuits w /Purchase 07/14/2010 $22.26
Service or Feeder
1 ea 12% State Surcharge - 07/14/2010 $14.76
Contractor: Electrical
P B ELECTRIC INC
1108 SE DOGWOOD LN
OAK GROVE, OR 97267
PHONE: 503 - 936 -5226
FAX: 503- 786 -6005
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $137.72
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 f• • , • : - - - - - by the Oregon Utility Notification Center. Those rules are set forth in OAR --
952- 001 -0010 through OAR • 2 -001 -0100. You may obtain a co. of estions to OUNC by calling 503.246.6699 or 1.800.332.2344. —
Issued By: ;i _ - �� i Perm ittee Sign
f t
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.
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.
t
Electrical Permit Application ,o,' 1 t I OIZ r)I I Icl :_ ONI N - •
Received
7 City of Tigard ,' ' ' v DateB Permit No.: `-- f _r
° 13125 SW Hall Blvd., T ard, OR 9 722 = ` (� -:.• r
g �0�� Plan Review Other Permit:
C Phone: 503.639.4171 Fax: 503.5911960 , \` , > C Date/B :
I 1 t; A R' I) Inspection Line: 503.639.4175 J , `., �'D Date Ready/By: ME ® See Page 2 for
Internet: www.tigard or.gov 4 t�3• 9�p � y 1, , ,1 Notified/Method: Supplemental Information
T, "OF WOR - �` V • PLAN REVIEW
❑ New constructio ddltion /alterat /rCp men[ 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.
❑ Demo]' ''on El 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
- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
El 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 ", "1 -3 ",
Job no.: Job site address: 7- C t ` 1001-11' or more. occupancy.
/ (y / J /lJ ix 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.: I Project name: ( ( ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qtv. I 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
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
/ - DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
41/4-2) / A-147 � b e_ residential (with above sq. ft.)
/ / Services or feeders installation, alteration, and/or relocation
\
200 amps or less 100.70 1(k.), yN 2
. ROPERTY .OWNER, I - . j , `❑ TENANT 201 amps to 400 amps 133.56 2
Name: I (�C( 1- iiVSt U 1 e1 rI C/�
401 amps to 1, 0 amps am 200.34 2
�J 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
y relocation
Phone: ( ) 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 I own which is not
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, er panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CO NTACT. PERSON above service or feeder fee,
each branch circuit 3 7.42 �� 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit • 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: /State /ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) 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: /� panel, alteration, or extension. Page 2 2
� 4_) � �/ / C Each additional inspection over allowable in any of the above
Address: // , ! E b L N Additional inspection (1 hr min) 66.25/ hr
r�` (" � �Z/ Investigation uila(t (1 hr min) 66.25/ hr
City /State /ZIP:
--] � -dt f [P 7 Industrial plant (1 hrmin) 78.1 S/ hr
Phone: ( ) I Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (V2 hr min)
CCB Lic.: Electrical Li 1r ` .► Suprv. Lic.: ` / S _ ELECTRICAL PERMIT FEES
/ 'j -- 71 1 1 _ — Subtotal: j �., q 6 Suprv. Electr t ai n e , required: _ ' — �— �� t ��/ plan review (25% of permit fee):
Print ram' j * /7:' Erb -. ,„, Date: -7_ / (( . (b _ State surcharge (12% of permit fee): / ig. /
TOTAL PERMIT FEE: i3? -
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
N um b er of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 461ST(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 .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
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 •
n Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ 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 07/01/10