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Permit
a CITY OF TIGARD ELECTRICAL PERMIT 1111 a COMMUNITY DEVELOPMENT Permit #: ELC2010 00557 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/08/2010 Parcel: 2S104AA04900 Jurisdiction: Tigard Site address: 12602 SW 127TH AVE Subdivision: BELLWOOD Lot: 18 Project: Freddie Mac Project Description: Reconnect only. Owner: FEES FREDDIE MAC Quantity Description Date Amount 33548 EDWARD LANE SCAPPOOSE, OR 97056 1 ea Reconnect Only 10/08/2010 $67.84 PHONE: 503-539-1117 1 ea 12% State Surcharge - 10/08/2010 $8.14 Electrical Contractor: PHONE: FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $75.98 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 - •ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those • les are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a co. of the 1 : • ::.•=ct questions to OUNC by calling 503.246. / 99 or 1.800.33' ' 344. By: Issued B ��t r Permitte S ignature: ILL 411, � ' k � 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. Cali 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 '1 fO It () I F I (. I: l � ti l.: O N1.1 City of Ti ar(� C� gJ Received g Date/13 © : d • Permit No.: ill . II Phone: 13125 SW Hall Blvd., Tigard, OR 97223 01 0 Plan Review � L �� — Phone: 503.639.4171 Fax: 503.598.1960 % 2 Date/By: Other Permit: i 1 i , i Inspection Line: 503.639.4175 �' A ,,,i)ate Ready/By: kris: 65 See Page 2 for Internet: www.tigard- or.gov oF .N1 . GIN n ted/Method: y Supplemental Information T t ' OF WORK C i %A vl PLAN REVIEW ❑ New construction ' P ' ddition/alteration/r Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Demoli on ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories. 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 INFORMA ION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", 100HP or more. occupancy. -� o Job no.: Job site address: " O 54 t) / � �� 0 or more residential units. ❑ Recreational vehicle parks. £ City/State /ZIP: - 97A-,7-- 3 ❑ Health -care facilities. ❑ Supply voltage for more than J ❑ 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: Description 1 Qty. 1 Fee. 1 Total [ • - 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 DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 E �� l Limited energy, multi - family 75.00 2 L L-CrD - RT — ec7c .. 2 residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation �� 200 amps or less 100.70 2 I'PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 Name: '' 401 amps to 600 amps 200.34 2 �(� 601 amps to 1,000 amps 301.04 2 Address: 33 j c pw,frt,,r, r Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City/State /ZIP:$[.-f-�j�5 .0- gy-esCo relocation Phone: 6 ) 637 - /i 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: 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) Each manufactured or modular City/State/ZIP: dwelling, service and/or feeder 67.84 2 Phone: ( ) Fax: : ( ) Reconnect only 6 7.84 r ; sq-e2 . Pump or irrigation circle 67.84 2 E -mail: f Sign or outline lighting 67.84 2 C07141ACTO Signal circuit(s) or limited- energy Business name: panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: Additional inspection (I hr min) 66.25/ hr Investigation (1 hr min) 66.25/ hr City/State /ZIP: Industrial plant (1 hr min) 78.18/ hr Phone: ( ) /FY( ) Inspections for which no fee is 90.00 / hr specifically listed (% hr min) CCB Lic.: Electrical ic.: Suprv. Lic.: ELECTRICAL PERMIT FEES Subtotal: 6 7. ct Suprv. Electrician signature, required: Plan review (25% of permit fee): -- Print name: //��/// Date: State surcharge (12% of permit fee): g • / Authorized signature: ;' TOTAL PERMIT FEE: 75' G ' /1 This permit application expires if a permit is not obtained within hin 180 6 days after it has been accepted as complete. Print name: fA / L 'l (` K % /C� This //1) • Number of inspections allowed per permit. 1:\ Building \Permits\ELC- PennitApp.doc 07/01 /10 440- 4615T(11 /05 /COM/WEB