Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2010 00520
T [GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/22/2010
Parcel: 2S104CA06500
Jurisdiction: Tigard
Site address: 13322 SW HILLSHIRE DR
Subdivision: HILLSHIRE Lot: 65
Project: Davis
Project Description: (7) branch circuits for basement.
Owner: FEES
DAVIS, CHESTER R & DEBORAH L Quantity Description Date Amount
13322 SW HILLSHIRE DR
TIGARD, OR 97223 7 crt Branch Circuits 09/22/2010 $100.70
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/22/2010 $12.08
Electrical
Contractor:
OWNER
PHONE:
FAX:
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 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 - the Oregon Utility Notification Center. Those rules •• et forth in OAR
952 - 001 -0010 through • = ' 952- 001 -0100. You may obtain a co• • I = • • estions to OUNC by calling 503.246.6699 or 11.800.332.234
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Issued By i �� � �� = � � � 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 FOR OrFIC:E USE ONLY
Received P ermit No.:
City of Tigard DateBy: q'» /p 67-3- �, r A. )0
V 13125 SW Hall Blvd., Tigard, OR 972 c Plan Review `
C Phone: 503.639.4171 Fax: 503.598.1100 q Q \ Date /By: Other Permit: mil. c).010— ch �,,
T I L. n K D Inspection Line: 503.639.4175 ` p !� Date Ready/By: 1 uris El See Page 2 for
Internet: www.tigard- or.gov SO r n 9C` ` ��,
Notified/Method: �Gp Supplemental Information
�. C)y\J
TYPE OF WORK \\ -4 QF � ` `\ , ,S� PLAN REVIEW
❑ New construction ,Py�Addition/alteration/r R t 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
X 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ A ", "E ", "1 - ", "1 - ",
1 Z2 , k; r 100HP or more. occupancy. parks.
no.: Job site address: 5 W v LL 5 f'C ❑ Six or more residential units. ❑ Recreational vehicle arks.
City/State/ZIP: n ❑ Health -care facilities. ❑ Supply voltage for more than
1 k c 6. 1 (O/\ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: J 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'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
rr Limited energy, multi - family 75.00 2
7 t'.k t •9 / � r r v •SP , r "e P ct e r 4, frn A_ res (with above sq. ft.)
Services or.feeders installation, alteration, and/or relocation
10 5 �� r.:11/4— t 1 rt Y
200 amps or less 100.70 2
'PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: c h e7 • N a.V . S / Q,iQ (rh� Ct1J 15 601 amps to 1,000 amps 301.04 2
Address: 3 ' Z v u3 k I ( I - re- i'' Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: bi rd i (D q — 7 Z2- 3 relocation
Phone: (57) ?j a D 11,9 (,,, 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
intended for sale -' - rent, or exChang-, . .srding to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
� Branch circuits — new, alteration, or extension, per panel
Owner Signs e: — t a! awl Date: 1 12 I A. Fee for branch circuits with
LICANT 0 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 56 1 8 2
Contact name: branch circuit
Each add'l branch circuit (p 7.42 q 9 . 52_
Address: Miscellaneous (service or feeder not included) -
Ci /StateJZ>P' 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: / panel, alteration, or extension. Page 2 _ 2
0 ci Ate / Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ he
Investigation (1 hr min) 66.25/ hr
City/State/ZIP:
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed ('/2 hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Subtotal: gyp. 70
Suprv. Electrician signature, required:
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): 1 2..0 8
TOTAL PERMIT FEE: 1 j2 . 7 8
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.