Permit CITY OF TIGARD ELECTRICAL PERMIT
I:, COMMUNITY DEVELOPMENT Permit #: ELC2010 00553
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2010
Parcel: 2S112CC17200
Jurisdiction: Tigard
Site address: 8412 SW COLTON LN
Subdivision: Lot: 0
Project: Elite Realty
Project Description: Reconnect only.
Owner: FEES
HOUSING OF URBAN DEVELOPMENT Quantity Description Date Amount
20829 72ND AVE S. #115
KENT, WA 98032 1 ea Reconnect Only 10/07/2010 $67.84
PHONE: 1 ea 12% State Surcharge - 10/07/2010 $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 suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through - 952- 001 -0100. You ... ...', _ • • _ • =s or direct questions to OUNC by calling 503.246. 99 or 1.800.332.2344.
Issued B • / /�� / _ Permittee Signature:
4.0 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.
CaII 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 `
City of Tigard � � R Datte/ . B B y: U v g 7T Permit No.: .FLC 1. ) _ 0 (.1 5c::::3 13125 SW Hall Blvd., Ti :: . a ' ' 72_ 1` i Plan Review 1 O V
a Phone: 503.639.4171 F: 503.598.1 ', -`. 11 V O Date/By: Other Permit:
r I i.:� It I:, Inspection Line: 503.639.417 ^ rP Date Ready/By: luiis: in See Page 2 for
Internet: www.tigard- or.gov O C a ® Notified/Method: j fit) - Supplemental Information
TYPE OF WORK .c: v 51 0" PLAN REVIEW
❑ New construction ❑ Addition/alteration/Iepltl S) Please check all that apply (submit a sets of plans w /items checked below):
i ❑ Savice or feeder 400 amps or more 13 Building over three stories.
❑ Demolition Other. -. 9� El the available fault current Marinas and boatyards.
CATEGORY OF CONSTRU 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
❑ Emergency system larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 0 10011P or more. occupancy.
D q f . S � J ( 1 - l r . L an" ❑ Six or more residential units. ❑ Recreational vehicle parks.
City ❑ Health -care facilities. ❑ Supply voltage for more than
ty ' CS■11 / Q 1Z ►� z 2' y ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt no.: ‘-f ` Proj naIne: . ❑ Savice or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Fee. 1 Taal 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. i1. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: '• Limited residential
' 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family
Re- ON/tie-C-1- clA) `/ residential (with above sq. ft.) 75.00 2
/ v / �l Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
FIzMs ih, u C A ✓ loc.--/ 4, I 401 amps to 600 amps 20034 2
Name: 4 0
C °J r/�MG^� 601 amps to 1,000 amps 301.04 2
Address: )--c)5,-)-ei v A TL S Tt. 1 Over 1,000 amps or volts 552.26 2
City /State/ZIP: U & �/,�' G (.)3a relocation or feeders installation, alteration, and/or
Phone: ( )
V � I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I on 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. ao l amps to 599 amps 168.54 2
Branch drafts - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 IS CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: c \ i v : v ��` t B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: )_, ,,‘, 6.41''' , n 9 branch circuit
/S \ A Each add9 branch circuit 7.42 2
Address: OI 19 S S. MO L \ \ a. Au C._ _ M (service or feeder not indeed)
Ci City/State/ZIP: Each �ufactured or modular
ty O ✓L ` C. � t a 1(l_ 9 0 (. r dwelling, service and/or feeder 67.84 2
Phone: (57 3) il ZZ - J o 73(f I Fax: : ( ) Reconnect only ] 67.84 4- p 2
Pump or irrigation circle 67.84 2
'^
E I✓ U ✓ r\ S [ 0 Cer C ILS •-. N G.# Signor whine lighting 67.84 2
CONTRACTOR 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 (1 hr min) 66.25/ hr
Inv
City/State /ZIP: estigation (1 hr min) 66.25/ br
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (Si hr min)
CCB Lic.: i •cal Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Subtotal: (07,.
Suprv. Electrician signs" . • req • :
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): a ' ii/
TOTAL PERMIT FEE: 75---. q,
Authorized Signature. This permit application expires if a perms is not obtained within 180
days after It has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.