Permit a �q CITY OF TIGAR® ELECTRICAL PERMIT
` COMMUNITY DEVELOPMENT Permit #: ELC2010 00380
Date Issued: 07/28/2010
T f A R Q 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S111DC11200
Jurisdiction: Tigard
Site address: 15810 SW OAK MEADOW LN
Subdivision: Lot: 0
Project: Clancy
Project Description: (1) 200 amps or less panel change
Owner: FEES
CLANCY, TOM & LINDA Quantity Description Date Amount
15810 SW OAK MEADOW LN
TIGARD, OR 97224 1 ea Services or Feeders - 200 07/28/2010 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 07/28/2010 $12.08
Electrical
Contractor:
WINNER ELECTRIC INC
5950 SW PROSPERITY PK
TUALATIN, OR 97062
PHONE: 503 - 638 -5028
FAX: 503 - 638 -4242
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.78
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 acc• • - - • - .proved 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. A ' ION: Oregon la req ' -- you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -04 -0010 through OAR 952 -001 -0 00. You m obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
ued By: Permittee Signature: )C ( )G.L( 2 ?„7s
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' p( $ d 5 S Date: 74 //�
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 ��� � : I (�RZ (l I Ic 1: us Oy�1
Received
City of Tigard �C,�� �, DateB : 7 A3 /d 4S, Permit No. aC� /O — DI_ to
: � ' 131 25 SW Hall Blvd., Tigard, OR 9 r,,,, Plan Re vi ,
� y Other Permit:
Phone: 503.639.4171 Fax: 503.590
DateB
1 1, - ; A RI Inspection Line: 503.639.4175 � ". G�R•Y i i, Date Ready/By: furls: ® See Page 2 for
Internet: www.tigard- or.gov o' o G'� -) ,5 ,\0 Notified/Method: it Supplemental Information
11 . , - TYPE •OF WORI�1\ '0 , s . G • PLAN REVIEW , • - .
❑ New construction ❑ Addition/alteratio %I cement 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.
lI CATEGORY OF' 1 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 ❑ CommerciaUindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
El
system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION
0 Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: c \ ��y 1ooHP or more. occupancy.
J is) b 7 ` w t -d"�^t t' t�Db�( ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: �� 7� sue C wt �� 9 ❑ Health -care facilities. ❑ Supply voltage for more than
C/ IC_ty ! I 7 ❑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: SQL 1$R¢3.0_ Description 1 Qtr. 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' 1 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
T14 Gi=1 A 1)4,7„, residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation _
200 amps or Tess / 100.70 2
_ . 111 PROPERTY OWNER - . ❑ TENANT 201 amps to 400 amps 133.56 2
• 401 amps to 600 amps 200.34 2
Name: LI it44,4 2L [A [/ 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: /State /ZIP: Temporary services or feeders installation, alteration, and/or
n relocation
Phone: 60 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, ter panel
Owner signature: Date: A. Fee for branch circuits with
li ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included) _
C i /State /ZIP: • - Each manufactured or modular
ty dwelling, service and/or feeder 67'84 2
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
11 CONTRACTOR • Signal circuit(s) or limited- energy
�; , C / - ` y panel, alteration, or extension. Page 2 2
Business name: u �� F itrCrl�t/�
Each additional inspection over allowable in any of the above
Address: 4c , QiP
S (Ai asa cty� t ' L /' b(, Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: ,l Investigation (1 hr min) 66.25/hr
T� 1.44: 'AS t 2 Q Z Industrial plant (1 hr min) 78.18 / hr
Phone: (445 ) 8 s a8 Fax: (6L3$) 0.3811.2 yg ✓ Inspections for which no fee is 90.00 / hr
IV
specifically listed (% hr min)
�i B Lic.: /,i Z Q ' -✓ Elect rical Lic.: 3 e f /Sp prv: Li c.: - �4a ELECTRICAL PERMIT. FEES
IT Suprv. Electrician signature, required: �j Subtotal: / �D,'7 j)
l� ciltli Plan review (25% of permit fee):
Print name: ••� Date: _ State surcharge (12% of permit fee): /,,z _ c) J `` W��� 7— /D C(-6-- J OTtTAL / PERMIT FEE:
Authorized signature:
n �'
g This permit application expires if a permit is not obtained within 180 — .4!/,'" .
rG '
days after it has been accepted as complete. c
Print name: Date: • Number of inspections allowed per permit. 11 0G
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‘
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
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n O ther:
COMMERCIAL WORK ONLY: • .
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n A • udio and Stereo Systems
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
n Instrumentation
Intercom and Paging Systems
—
❑ 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 07/0 I/I 0 ,.