Permit III CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 00001
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/04/2011
Parcel: 2S102BA00500
Jurisdiction: Tigard
Site address: 9760 SW TIGARD ST
Project: Jackson Subdivision: Lot: 0
Project Description: Replace meter and panel.
Contractor: NORMANDIN ELECTRIC Owner: JACKSON, PAUL R & SIMONE D
51086 NW CLAPSHAW HILL RD 10250 TIGARD ST
FOREST GROVE, OR 97116 TIGARD, OR 97223
PHONE: 503 - 357 -5380 PHONE: 503 - 888 -8407
FAX: 503 - 357 -4878
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 01/04/2011 $100.70
Specifics: amps or less
13 crt Branch Circuits w /Purchase 01/04/2011 $96.46
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 01/04/2011 $23.66
Electrical
Type of Const:
Occupancy Grp:
Total $220.82
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 • er applicable law. All work will
be done accor•- -- with approved plans. This permit will expire if work is not started within 180 days of issuance, or if w', is suspended for more the 180
days ATTENTION: Ore• •n la, requires you to follow the rules adopted by the Oregon Utility • • / . ' .se rules are set forth in OAR
95 001 -0010 through OAR 9 — 001 —d • • 0. You may obtain a copy of the rules or direct questions to OUN 4 • • .332.2344.
- ued By: ■ 0 /� , Permittee Signata �, •Ab,&
OWNER INSTALLATION ONLY
, AM°
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' '' , - I F Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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 Applicatiop _ � ` g %/ED FOR OFFICE USE ONLY
City of Tigard • " G Received Datem : f �� C Permit No.: o ..,„„
13125 SW Hall Blvd., Tigard, OR 97223 II Plan Review
' I C ` Phone: 503.718.2439 Fax: 503.598.196 N V 3 L U l DatelB : _ Other Permit:
TWA It D Inspection Line: 503.639.4175 Date Ready/By: • kris: ® See; Page 2 for .
Internet: www.tigard- or.gov CITY OFTiGRRD Notified/Method: Supplemental Information
TYPE OF WOI2 DIVISION 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
• g1-. 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 ",
._ 100HP or more. - occupancy.
Job no.: Job site address: G / ! 7� !? ,St / / 3 a ' $T ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ❑ Health -care facilities. 1:1 Supply voltage for more than
I ( i 4 TA l ` ❑ Hazardous locations. 600 volts nominal.
- Suite/bldg. /apt. no.: i Project name: • • ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/direction t o j s • Description I Qty. I Fee. I Total k•
New residential single- or multi- family dwelling unit. .
Includes attached garage.
Subdivision: L ot 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.: I Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited, energy, multi-family 2
/ c c ri 4 4 d— 74 L / residential (with above sq. R . )
j / Services or feeders installation, alteration, and/or relocation
200 amps or less ( 100.70 )ob . 7z, 2
® PROPERTY OWNER I ❑ TENANT ' 201 amps to 400 amps • 133.56 2
/
401 amps to 600 amps 200.34 2
Name:
pRL 5 Ac /cS0i(/ 601 amps to 1,000 amps 301.04 2
•
Address: i 01 - I ,,) — i Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP; r Itf i t AL Q 7 . / relocation -
Phone: ( 10 3) $$8 -gy Fax: (. )
200 amps or less - 59.36 1
- 201 amps to 400 amps 125.08 2
Owner installation: This install ion is being made on property that I own which is not 401 am to 599 amps 168.54 2
intended for sale lease, rent, or change, according to ORS 447,,449, and 701. -
Branch circuits — new, alteration, or ex tension,'per panel
Owner signatu • - Date: ' . A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder -fee, 7.42 C
each branch circuit /3 6 e96 2
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)
Ci /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..
/ i :,,j I 'panel, alteration, or extension. - Page 2 2
Business name:
/ V rrvr p 4 � �1 e t 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
r[ S r ro v`- 0/? ( /G Industrial plant (1 hr min) 78:18 / hr
Phone: (5 ) 33 - 7 _53 8 Fax: (5' ?) 357 _y e )e5.- Inspections for which no fee. is 90.00 / hr
specifically listed (%2 hr min)
CCB Lic.: 640 , 8- i 1 Electrical Lie.: 31e. Suprv. Lic.: 3 35,9 f ELECTRICAL PERMIT FEES
7/P• 1!/ f 7/1/I! • lab //S Subtotal. /77 , (p
Suprv. Electrician signature, it/ 1.9., Plan review (25 % of permitfee):
Print name: 3 ,. , /l � Cr : , • Date: State surcharge (12 %of permit fee):. a3 4(a
TOTAL PERMIT FEE:
Authorized signature: ' -- This permit application expires if a permit is not obtained within 180 .
days after it has been accepted as complete. r
Print name: Date: • N um be r of inspections allowed per permit. t� �/� � �
1:\Building\Pennits\ELC- PermitApp.doc 07/01/10 410- 4615T(11 /05 /COM/WEB � ' "� (jy.V13 �y
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
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
TI 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- PetmitApp.doc 07/01/10