Permit CITY OF TIGARD - ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00503
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/15/2010
Parcel: 2S111DB09800
Jurisdiction: Tigard
Site address: 15515 SW OAKTREE LN
Subdivision: Lot: 0
Project: Sacconaghi
Project Description: (3) branch circuits for furnace and A/C reconnect.
Owner: FEES
SACCONAGHI, RODNEY W & Quantity Description Date Amount
SACCONAGHI, SANDRA F, 15515 SW
OAKTREE LN 3 crt Branch Circuits 09/15/2010 $71.02
wo /Purchase Service or
PHONE: 503 - 620 -3520 Feeder
1 ea 12% State Surcharge - 09/15/2010 $8.52
Electrical
Contractor:
PHONE:
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. At work wit
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 i. - - •.o•ted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through O • : • .2-001-0100. You may • - -' = -; • • _ • irect questions to OUNC by calling 503.246.6699 or 1. .2344.
/ r
Issued _ — �. Permittee Signature:
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 ' Received
r• O It O 1.1.1( I: us l: O,N I . Y
City of Tigard �` Date/B : Permit No.: (�� _ U
13125 SW Hall Blvd., Tigard, OR 9722 �� '
C Phone: 503.639.4171 Fax: 503.598.1960 ` ` V ( � �0 Plan Review Other permit: - - i G A � �� Inspection Line: 503.639.4175 S P� D ate DateDate/13 : Ready/By: brio: ® See Page 2 for
Internet: www.tigard- or.gov GO O * �71D Supplemental Information
TYPE OF WORK k %Ow.) V PLAN REVIEW
❑ New construction ddition/alteration/r acement 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
3 241- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pimp. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "1 - ",
Job no.: Job site address: i +j 5 5) O a k es loot - >P or more. occupancy.
1 , t� ❑ Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: ❑ He alth care faciliti ❑ Supply voltage for more than
ty i �� O rd e t2 n 2 Z y 600 volts nominal.
❑ Hazardous locations.
Suite/bldg. /apt. no.: Project name: &i tttiAlOi i ❑ 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.)
n , I Limited energy, multi - family
75.00 2
.nM,t. .3(..- /-f C._ 2,e_ c.,, e4 . t at-Ark. o r residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
0 L'+4__ k. — 200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 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
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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, 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: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 5 t r 2
Contact name: branch circuit
Each add'I branch circuit Z 7.42 1(4 ■ (.412
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67 84 2
City/ State/ZIP: 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
SI ^"'� l� � C�c Each additional inspection over allowable in any of the above
Address: `S 1 V S L.) ^ Additional inspection (1 hr min) 66.25/ hr
/ V _ Investigation (1 hr min) 66.25/ he
City/State/ZIP: (vp�e,r, ( .a ) fa.. oy Industrial plant (1 hr min) 78.18/ hr
Phone: ( ,'O3) cu '( _ 3 o q S I Fax: ( ) Inspections for which no fee is 9000/ hi
specifically listed (V2 hr min)
CCB Lic.: 161 CH ! Electrical Lic.: C 2 (,, Suprv. Lic.: 3853 S ELECTRICAL PERMIT FEES
Subtotal: - /.d),
Suprv. Electrician signature, required: - j / ' Plan review (25% of permit fee):
Print name: µ cz D ate: State surchar (12 of perm fee): .
Si� G IS 9 t' - 10 �
TOTAL PERMIT FEE: 7• 5--G, AutnoriZed Signature: This permit application expires if a permit is not obtained within 180
d ays after it t has been accepted as complete.
Pri nt name: 3 .3� Date: q _ / (l .—/ • N umber of inspections allowed per permit.