Permit a CITY OF TIGARD ELECTRICAL PERMIT
1111 • COMMUNITY DEVELOPMENT Permit #: ELC2010 00586
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/22/2010
Parcel: 2S103CA03400
Jurisdiction: Tigard
Site address: 11555 SW TERRACE TRAILS DR
Subdivision: Lot: 0
Project: Bergstrom
Project Description: Panel replacement.
Owner: FEES
BERGSTROM, DENNIS T AND DAWNA L Quantity Description Date Amount
11555 SW TERRACE TRAILS DR
TIGARD, OR 97223 1 ea Services or Feeders - 200 10/22/2010 $100.70
amps or less
PHONE: 2 crt Branch Circuits w /Purchase 10/22/2010 $14.84
Service or Feeder
1 ea 12% State Surcharge - 10/22/2010 $13.86
Contractor: Electrical
FRAHLER ELECTRIC CO
11860 SW GREENBURG RD
TIGARD, OR 97223
PHONE: 503 - 639 -4627
FAX: 503 - 639 -4673
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $129.40
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. Yo • - - - • • - copy ;4146 . - s or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
c
Issued B • Permittee Signature:
.1111.5.11
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 pemdt 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 OFFICE USE ONLY
City of Tigard �O Rece Plan i Review
ved
`� Date/By: iU ?-1 1 J fi Permit No.: o` �1D C7Q
— c P
1
0 13125 SW Hall Blvd., Tigard, OR 97
C Phone: 503.639.4171 Fax: 503.598 010 Date/By: Permit:
1
I . �, r D Inspection Line: 503.639.4175 S 1 �- Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- Or.gov OC \ . Notified/Method: - pro Supplemental Information
TYPE OF WORK IN 0 �j r ` o S \O� PLAN REVIEW
❑ New construction ® Addition/alteration/ t V ` Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑ Other: A ❑ Service or feeder 400 amps or more ❑ Building over three stories.
V 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 INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: 67927 Job site address: 11555 SW TERRACE TRAILS DR.
or more. occupancy.
❑ Six x o or r more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: TIGARD OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 1 Project name: BERGSTROM RESIDENCE ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
Description I 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
REPLACE ELECTRICAL PANEL Limited energy, > att�favtent�ly ft.)
residential 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 1 100.70 100 70 2
❑ PROPERTY OWNER • ❑ 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: Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
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 ❑ CONTACT PERSON above service or feeder fee, 2 7 42 14. 84 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 I 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: FRAHLER ELECTRIC COMPANY panel, alteration or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 11860 SW GREENBURG ROAD Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Investigation (1 hr min) 66.25/ hr
TIGARD OR 9722 Industrial plant (1 hr min) 78.18/ hr
Phone: ( 503 639 -4627 Fax: ( 503 ) 639 -4673 Inspections for which no fee is
specifically listed (Y2 hr min) 90.00/ hr
CCB Lic.: 37410 Electrical Lic.: 34 -13C Suprv. Lic.: 1816S ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician signature, rt)r 4 e/y Plan review (25% of permit fee): 115.54
Print name: R. W. FRAHLER Date: 10/19/10 State surcharge (12% of permit fee): 13. a,6 n'
TOTAL PERMIT FEE: 129.40
Authorized signature:
This permit application expires if a permit is not obtained wttmn
Print name: Date: • days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: \ Building \Permits\E.C- PermitApp.doc 07/01/10 440- 4615T(1I /05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY::
Fee for all 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 Involved:
❑ A udio and Stereo Systems
❑ B oiler Controls
❑ Clock Systems
❑ D ata 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
1:\ Building \Pamits\ELC- PermitApp.doc 07/01/10