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Permit /(fr//o Re l orim-eifier/Indcoz/d, C,J 0 G,► a CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC201000451 T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/26/2010 Parcel: 1 S 136CA07300 Jurisdiction: Tigard Site address: 11045 SW 78TH AVE Subdivision: PP1993 -035 Lot: 1 Project: Hall Project Description: Panel replacement. 11/05/10 added (1) 200 amp feeder. BT. Owner: FEES HALL, REBECCA Quantity Description Date Amount 11045 SW 78TH AVE TIGARD, OR 97223 1 ea Services or Feeders - 200 08/26/2010 $100.70 amps or less PHONE: 1 ea 12% State Surcharge - 08/26/2010 $12.08 Electrical 1 ea Services or Feeders - 200 11/05/2010 $100.70 Contractor: amps or less OWNER 12 da 12% State Surcharge - 11/05/2010 $12.08 Electrical PHONE: FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $225.56 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 eater Thos- es -re set forth in OAR 952- 001 -0010 through OA; 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calli - -.46.6699 or 1. ;; 1. - 2.23.4. Issued B ! _ _ �.� _ Permittee Signatu i Mip!L /• 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. CITY OF TIGARD ELECTRICAL PERMIT .11, COMMUNITY DEVELOPMENT Permit #: ELC2010 -00451 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/26/2010 Parcel: 1 S 136CA07300 Jurisdiction: Tigard Site address: 11045 SW 78TH AVE Subdivision: PP1993 -035 Lot: 1 Project: Hall Project Description: Panel replacement. Owner: FEES HALL, REBECCA Quantity Description Date Amount 11045 SW 78TH AVE TIGARD, OR 97223 1 ea Services or Feeders - 200 08/26/2010 $100.70 amps or less PHONE: 1 ea 12% State Surcharge - 08/26/2010 $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 woc spended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification C :. - chose rules .re set forth in OAR 952- 001 -0010 throne • • R 952 - 001 -0100. You ma obtai • of the rules or direct questions to OUNC by calling 50 ' •1.801. 1344. �:�� Issued ,.� =� Permittee Signature: 1.•, F ` 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 IO R O r I I c [; USE ()NIA Y City of Tigard p Date/B j •��i smut No .: — f , . a 131 25 SW Hall Blvd., Tigard, OR 97223 `Lp Plan Review C Phone: 503.639.4171 Fax: 503.598.1960 \\ G Date/B : Other Permit: i _ �, It D Inspection Line: 503.639.4175 P Date Ready/By: ®See Page 2 for Internet: www.tigard- or.gov • Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction Addition/alteration /replacement Please check all that apply (submit a 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 ® 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 em. larger separately derived system. ❑ Addition o new of motor load of ❑ "A ", "E', "l -2 ", "1 -3 ", Job no.: Job site address: //0955 5�) i l�oroomore. occupancy. /�!/� ❑ Six or more residential units. 0 Recreational vehicle parks. City/State/ZIP: 72 41. 4 , 0 i e g ?2 2-3 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ 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: / tU 99 Description I Qty. I 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 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Po Limited energy, multi-famil 75.00 2 AlWI a residential (with aboove e sq. q. ft.) _ Services or feeders installation,alteration, and/or relocation 200 amps or less 1 100.70 10t)_ 7C 2 Al PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 133.56 2 /_/4.44, 401 amps to 600 amps 200.34 2 Name: �CG�c 601 amps to 1,000 amps 301.04 2 Address: j,0 i t ,) V s •6 .114 . Over 1,000 amps or volts 552.26 2 o Temporary services or feeders installation, alteration, and/or City/State/ZIP: / 4 6 9) Z 23 relocation Phone: (603) b 3 5, I Fax: (.!U 3 9 90- 7Y2 Z 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: • 's r • • e on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, g to ORS 447, 449, 670 d 711. d� , �� Branch drcuits - new, alteration, or ex tension, per panel Owner signature: . — %</. , ,.. i •.. �i Date: A. Fee for branch circuits with rteems. � � ❑ '' ' I ANT ' 1 '� ❑ CONTACT ' RSON 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) City/State/ZIP: /S[ate/ZIP: Each manufactured or modular 67 84 2 Y dwelling, service and/or feeder Phone: ( ) I 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 ��/V'� Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ hr City /State/ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: ( ) I Fax: ( ) Inspections for which no fee is 90.00/ hr specifically listed (i hr min) CCB Lic.: I Electrical Lic.: I Suprv. Lic.: ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: J(.Z'1. T O Plan review (25% of permit fee): _ — Print name: i Date: P j6- State surcharge (12% of permit fee): /61,08 �� (f� � TOTAL PERMIT FEE: / 1 Authorized si _ a 1 ' : /V ' 1 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: I Date: • Number of inspections allowed per permit. I:\ Building \Permits\ELC- PennuApp.doc 07/01 /10 440-4615T( 11/05/C0144/WEB Electrical Permit A � lication �o FoR OFFICE: usi.: ONLY City of Tigard e O Received `J ( a 1 O\ DateB : ( V // 1 3125 SW Hall Blvd., Tigard, OR 7 V Plan Review C Phone: 50 Fax: 503.5 8. 196 S PC` ``11 QO DateB Other Permit: i 1 i . 1 Inspection Line: 503.639.4175 \ .� \G V , Date Ready/By: ® See Page 2 for Internet: www.tigard or.gov CJ O\ � Notified/Method: Supplemental Information TYPE OF WOR if PLAN REVIEW ❑ New construction ❑ Addition/alteratio r eplacement 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 ❑ 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 - ", "1 - ", Job no.: Job site address: 0 , ( � . . , 100HP or more. occupancy. S (.� • Aire ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: H " ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description 1 Qtr. 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 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 75.00 2 V 664 t h 4 / f k t S pen, r t1- residential (with above sq. ft.) Services or feeders installation, alt ration, and/or relocation 200 amps or less 100.70 /(w, 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 1 201 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 I ❑ 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) City/State/ZIP: 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 Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: Investigation (I hr min) 66.25/ hr Industrial plant (1 hr min) 78.18 / hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr specifically listed (V2 hr min) _ CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: W O . 7 J Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): j ). - f) TOTAL PERMIT FEE: 1 1 a -7 i 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. 1: \Building\Permits\ELC- PermitApp.doc 07/01 /10 440- 4615T(11/05 /COM/WEB =' Information Notice to Owners About Construction Responsibilities �t. (ORS 701.055 (5)) Homeowners acting as their own general contractors to construct a new home or make a substantial improvement to an existing structure, can prevent many problems by being aware of the following responsibilities: • Homeowners who use labor provided by workers not licensed by the Construction Contractors Board, may be considered an employer, and the workers who provide the labor may be considered employees. As an employer, you must comply with the following: • Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503 - 378 -4988. • Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503 - 947 -1488. • Oregon's Business Identification Number (BIN): is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503 - 945 -8091 or go to bttp: //+ww•oregon.gov /DOR /BUS /docs /211- 055.pdf for the appropriate forms. • Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs if one of your workers is injured on the job. For more information, call the Workers Compensation Division at the Department of Consumer and Business Services at 503 -947 -7815. • Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 1- 800 - 829 -4933 or visit their website at www.irs,gov. Other Responsibilities of Homeowners: • Code Compliance: As the permit holder for a construction project, the homeowner is responsible for notifying building officials at the appropriate times, so that the required inspections can be performed. Homeowners are also responsible for resolving any failure to meet code requirements that may be found through inspections. • Property Damage and Liability Insurance: Homeowners acting as their own contractors should contact their insurance agent to ensure adequate insurance coverage for accidents and omissions, such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not otherwise covered as employees by Workers Compensation Insurance. • Expertise: Homeowners should make sure they have the skills to act as their own general contractor, and the expertise required to coordinate the work of both rough -in and finish trades. CONSTRUCTION CONTRACTORS BOARD 700 Summer St NE, Suite 300, PO Box 14140, Salem, OR 97309 -5052 Telephone: 503 - 378 -4621 — Fax: 503 - 373 -2007 Website Address: www.oregon.gov /ccb f /property_owner adopted 12 -04 -07 This Copy for Permit Applicant Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. Print = • ' nnit • - t r ifrab ,1,d Si • i ature of -nt Date / Permit #: et-Cg-C) I 005 / �- Address: l( O k S S ttl . ` TaOord 012 9•a1a-? :' Issued by: 6 M. Date: TO-6 / 0 i:1 This Copy for Permit Offices 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: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC p 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 \Permits\ELC- PermitApp.doc 07/01/10