Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 00438
T [ G . . I D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/25/2010
Parcel: 2S111CC23100
Jurisdiction: Tigard
Site address: 10430 SW GREENLEAF TER
Subdivision: Lot: 0
Project: Avena
Project Description: (2) branch circuits for furnace and a/c reconnect.
Owner: FEES
AVENA, MARIAN Quantity Description Date Amount
10430 SW GREENLEAF TERRACE
TIGARD, OR 97224 2 crt Branch Circuits 08/25/2010 $63.60
wo /Purchase Service or
PHONE: 503 - 684 -0376 Feeder
1 ea 12% State Surcharge - 08/25/2010 $7.63
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 $71.23
Required Items and Reports (Conditions)
This permit is ued-•s •'ect 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 ccordance wit - pproved 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 i NTION: Oregon la • r:: •'res you to follow the rules adopted by the Oregon Utility Notification Center, Those rules are set forth in OAR
952 -001- 010 through OAR 952 -0 ' - 010 ¥ u may
/j o ob btainn a copy of the rules or direct questions to OUNC by calling 503.246.6699 0 1.800.332.2344.
Issue y: " �" `� `" Pe rmittee Signature: X-
j
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' X Date: jriadc
LICENSE NO. y �
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 Appl c' ¢ \ I OR OI FICI•: UJSl O III City of Tigard 1 I5 201 DateB : D / 0 Permit No.: C j`(J _X 9,3 gi
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
0 Phone: 503.639.4171 Fax: 503.598.1960 B Other Permi fie „40/6.- 6o 7
n - Y .. Date : l /
Inspection Line: 503.639.4175 r • ° y , •, . �) Date Ready/By: Jur ® See Page 2 for
I ICi ; .r , l i , .
t<a, i
Internet: www.tigard- or.gov i � 1 �P i , 8 � /, .. Notified/Method: Supplemental Information
TYPE OF WORK - . '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 ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
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 Toad of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
CGJ 6k L r S ix or or more. occupancy.
Job no.: Job site address:/0q30
�+ �e� ❑S ix or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: f 4.,A0e 97 ❑ Health-care facilities.
❑ Supply voltage for more than
/ ['Hazardous dous 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
" ,4a—Ce A/c /e ✓te-C----t residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
TPROPERTY 'OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: �/j/� pt� v L p h� 401 amps to 600 amps 200.34 2
/� /Q�l�Gd1 v 1 601 amps to 1,000 amps 301.04 2
Address: /Q t f 3 p S bc) GoLe..GriCeGi Over 1,000 amps or volts 552.26 2
� � yy Temporary services or feeders installation, alteration, and /or
City /State /ZIP:
�y 4_120 97 2- ZL/ relocation
Phone: (5p3) & S f -0 3 7( 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
APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: , 4dz to CZLcT� /� S B. Fee for branch circuits without
service or feeder fee, first
/ 56.18 r / 2
Contact name: %r��D branch circuit �`t'
Each add'I branch circuit I 7.42 749- 2
Address: g-/S- `/)y6 C/22.,s Miscellaneous (service or feeder not included)
City/State/ZIP: Qy 47°----7 Each manufactured or modular 67.84 2
y LAS 6 dwelling, service and/or feeder
Phone: (c63) 76 (---Ll0 0 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:A /G 120_, 4L, i ' he. K.. G� s panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Slis" 6") //Lc t d Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: C S}c9-`y '70 2 - 7 Investigation (1 hr min) 66.25/ hr
j Industrial plant (1 hr min) 78.18/ hr
Phone: (gP) 72,..2.,-/ 5-'S Fax ( ) Inspections for which no fee is
specifically listed (Y2 hr min) 90.00 / hr
CCB Lic.: / , O 3 0 i Electrical Lic.: 3 - Suprv. Lic.: y2,Z�S ELECTRICAL PERMIT FEES.
Suprv. Electrician signature, required: Subtotal: 6, ? , i!Pv
e Plan review (25% of permit fee): ._ .„,e9t.-- Print name: ,ch.,, L_,4 &.),, „L _LIZ Date: (Z Si/ 0 State surcharge (12% of permit fee): /. 6'3
TOTAL PERMIT FEE: '7 j . a3
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: i,, -� r j Date: f/2, '1/() y days after it has been accepted as complete.
Number of inspections allowed per permit.
1:\Building\Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(OI /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 Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY: • .
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ C lock Systems
❑ Data Telecommunication Installation
n F ire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n N • urse Calls
❑ Outdoor Landscape Lighting*
n 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