Permit ‘,.w.Npvtv CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00350
Date Issued: 07/09/2010
t GARI7 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1 S136CB09300
Jurisdiction: Tigard
Site address: 11216 SW 81ST AVE
Subdivision: HERB + PEGGY'S PLACE Lot: 21
Project: Spiering
Project Description: (3) branch circuits for furnace and heat pump.
Owner: FEES
SPIERING, COLLEEN A Quantity Description Date Amount
11216 SW 81ST AVE
TIGARD, OR 97223 3 crt Branch Circuits 07/09/2010 $71.02
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/09/2010 $8.52
Electrical
Contractor:
AFFORDABLE ELECTRIC WORKS LLC
545 COLLINS CREST
GLADSTONE, OR 97027
PHONE: 503 - 722 -1558
FAX:
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 r o les R e o h in OAR
952- 001 -0010 through OAR 952- 001 -0100. You may obtain a copy a rules o direct questions to OUNC by calling 503. r A0/ • 2.344.
Issued By: ∎ Permittee Signature:
/ P
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.
� �
Electrical Permit Application �� �XN , 1 ' ; I c)I cii I I( l uSl c)��1 1 , , -. ,
IN � City of Tigard
Date
Q
ti 13125 SW Hall Blvd., Tigard, OR 97223 Q Plan Review
i1I Permit No.: - di. _ At C • Phone: 503.639.4171 Fax: 503.598.1960 , Ri f Date/ : Other Permit: EC m _ �`*
l - 1 ,. , t) Inspection Line: 503.639.4175 F'S1 C % e Ready/By: VI See Page 2 for
Internet: www.tigard {'� l O Cr �1 v�J otitied/Method: Supplemental Information
TYPE OF WORK Wk � , 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 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
Multi - family 0 Master builder 0 Other: 0 Fire pump. ❑ Installation of 75 KVA or
JOB SI E 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: // IOOHP or more. occupancy.
// /It , GJ 1 ea. Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: — rC �L ❑ Health -care facilities. ❑ Supply voltage for more than
l ❑ 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: 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
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
. CG FLAILAJA i' a -4 P 11-1 ' 110 l 6 Fc1 ��iCIiT 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: Ci/em Si ,(
401 amps to 1, 0 amps 200.34 2
(� 601 amps to 1,000 amps 301.04 2
.Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: 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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
0 APPLICANT 1 14 CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
J I Q J /� /� � ,r, )„ ✓G. t L B. Fee for branch circuits without
Business name: � 7 GC. (,��(� - �- (f� w
service or feeder fee, first 56.18 2
Contact name: b J� � dz branch circuit
6� " Each add'I branch circuit d,Ll . 7.42 2
Address: ¶1_ s' c w frus 1 -S t Miscellaneous (service or feeder not included)
��''` / t ( Q Each manufactured or modular
City /State /ZIP:
�7 f. € �5-�o�� G 1 70 27 dwelling, service and/or feeder 67.84 2
Phone: (5 3) 7 1 1 c.)b 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: 4 ,,, „a g e..„_ V <_ e 5 panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address:.5 .g - ( G' S Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: G t /-0 O cf) 0z7 Industr at p a (1 1 min) 66.25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: ( g'd2 ) 72, 153 Fax: Inspections for which no fee is
� ax: ( ) 90.00/ hr
specifically listed CA hr min)
CCB Lic.: / 0 6 ,�j Electrical Lic.: -Sgs Suprv. Lic.: (12 ELECTRICAL PERMIT FEES
/ V j I t1 k 1 / Subtotal: 7 I, o›- Suprv. Electrician atu e, a wired: 7 �t / ( Plan review (25% of permit fee):
Print name: /e icd ” Ckk i-, Date: State surcharge (12% of permit fee): -,. 5
TOTAL PERMIT FEE: --, r c
Authorized Signature: L i e
�, This permit application expires if a permit is not obtained within 180
M
days after has been accepted as complete.
Print name: �, Date: Number of inspections a llowed per permit.
C1 Building1Permits lELC- PermitApp.doc 0710 1/10 440- 4615T(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*
n B • urglar Alarm
n G • arage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
`COMMERCIAL WORK ONLY: ' . 1
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
n HVAC
n I • nstrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n M edical
n Nurse Calls
❑ Outdoor Landscape Lighting* •
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10