Permit CITY OF TIGARD ELECTRICAL PERMIT
l: • COMMUNITY DEVELOPMENT Permit #: ELC2010 -00478
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/07/2010
Parcel: 2S104ACO3100
Jurisdiction: Tigard
Site address: 12445 SW 134TH AVE
Subdivision: MORNING HILL NO. 8 Lot: 175
Project: Neet
Project Description: Panel change and (2) branch circuits for kitchen remodel.
Owner: FEES
NEET, BRIANA M & HINESLY, PAULINE M Quantity Description Date Amount
12445 SW 134TH AVE
TIGARD, OR 97223 1 ea Services or Feeders - 200 09/07/2010 $100.70
amps or less
PHONE: 503 - 329 -2889 2 crt Branch Circuits w /Purchase 09/07/2010 $14.84
Service or Feeder
1 ea 12% State Surcharge - 09/07/2010 $13.86
Contractor: Electrical
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $129.40
Required Items and Reports (Conditions)
This permit ' issued subject the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don in accordance with approv • 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 requi you o follow the rules adopted by the Oregon Utility Notification 'en : Those rules are set forth in OAR
952 01 -0010 through OAR 952 -001 -0 •0. You r - •.tain a copy of the rules or direct questions to OUNC by calling 503.241.66 or \ 0. .'.2344.
I ued By: ■1 ..�.. I _ Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on pro •• , i which is not intended for - = le, tease or cent.
1 . :. , / OWNER'SSIGNATU� - -� % +.0 O—�— 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 Ume of each inspection.
•
Elec rical Permit A licati EC E I V ED
City of Tigard n By: 9 q .o Pe No.: E t pa r 7 $
11 II 13125 SW Hall Blvd., Tigard, OR 9722 E P 0 7 2010 Date/By:
Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
. \ , i „ Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: 'mist la See Page 2 for
Internet: www.tigard -or.gov BUILDING DIVISION Notified/Method: _ Supplementallnformadon
TYPE OF WORK PLAN REVIEW
❑ New construction MI 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.
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
less to ground, all other er alga ons. ❑ com -ace agricultural
rY g 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.
o
❑ Addition of new motor load of 0 "A", "E E"", , " "11 -2 "", , °1 -3 °,
Job no.: Job site address: i L 4,8--- so 1 3 y "' 44. o more. occupancy.
_ ❑ Six ix o or r more re residential units. ❑ R ecreational vehicle parks.
q a , l' 2 9 u� ❑ Health -care facilities. ❑ Supply voltage for more than
City/State/ZIP: , J ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: EN 4414 ne t. f 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: /
� (Ala n LA / 13 i.s t^ Description 1 Qrv. 1 Fa. 1 Todd I •
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'I 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
/// J +- L(/1,( er- [ ,• ,i f (,` i /Yll�s -d 6�a.c-e, residential (with above sq. ft.)
/ Services or feeders installation, alteration, and/or relocation
e . P / l ; ; ,- i c. 200 amps or less L 100.70 / ( 70 2
N P ROPERTY OWNER ( ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: g r—; a f O` Al . _ + 601 amps to 1,000 amps 301.04 2
Address: /Z 44 C t' / .14. 'U1 Over 1,000 amps or volts 552.26 2
City/State/ZIP: `l Temporary services or feeders installation, alteration, and/or
Ci
ty j ; Q ,_n 0 e 9 7 ZZ, j relocation
Phone: (5-03) 3 Z. _L w`/ 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, l rent, or exchange, according to ORS 447, 449, 670, and 701.
L Branch circuits — new, alteration, or extension, per panel
Owner signature: /7-eel- Date: 9/3/ (> A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, Z, 7 42 ( � g Lf 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, fast 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/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: O u),4) t4 panel, alteration, or extension. _ Page 2 - 2
Each additional inspecdon over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90 hr
specifically listed (%z hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Subtotal: / /S' . VI
Suprv. Electrician signature, required: o
Plan review (25% of permit fee): -e^
Print name: Date: State surcharge (12% of permit fee): /5
TOTAL PERMIT FEE: / 9.9 • of O
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
I: \BuildingPermitr\ELC- PermitApp.doc 07/01/10 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
{ RESIDENTIAL WORK ONLY:
Fee for X 11 residential systems combined ... $75.00
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 $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Invoked:
❑ 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:
*No licenses are required. Licenses are required
for all other installations
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