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Permit
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CITY OF TIGARD ELECTRICAL PERMIT ': g COMMUNITY DEVELOPMENT Permit #: ELC2011 00009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/04/2011 Parcel: 2S103AC08000 Jurisdiction: Site address: 11387 SW FONNER ST Project: Bourke Subdivision: ERVIN /STARK PARTITION tot: 0 Project Description: (1) branch circuit for recessed lighting on patio. 115/11 reprinted permit to include low voltage for stereo system. _' BT. •—. — Contractor: OCHSNER ELECTRIC INC Owner: BOURKE, ERIN 8724 SE YAMHILL ST 11387 SW FONNER ST PORTLAND, OR 97216 TIGARD, OR 97223 PHONE: 503 - 254 -0015 PHONE: 503 - 858 -5883 FAX: 503 - 254 -8126 FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 01/04/2011 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 01/04/2011 $6.74 Type of Use: SF Electrical - Class of Work: ALT • 1 ea Limited Energy 01/05/2011 $75.00 Type of Const: 9 12% State Surcharge - 01/05/2011 $9.00 --- Electrical Occupancy Grp: Total $146.92 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 rk is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification C- h e rules are set forth in OAR 952- 001 -0010 through OAR - 001 -0090. You may of the rules or direct questions to OUNC by calling 503.23 ' I 1.800.3 .2344. Issued By: Permittee Signature: �� ' : _ .... i --" 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 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. q CITY OF TIGARD ELECTRICAL PERMIT ' . I ' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/04/2011 Parcel: 2S103AC08000 Jurisdiction: Site address: 11387 SW FONNER ST Project: Bourke Subdivision: ERVIN /STARK PARTITION Lot: 0 Project Description: (1) branch circuit for recessed lighting on patio. Contractor: OCHSNER ELECTRIC INC Owner: BOURKE, ERIN 8724 SE YAMHILL ST 11387 SW FONNER ST PORTLAND, OR 97216 TIGARD, OR 97223 PHONE: 503 - 254 -0015 PHONE: 503 - 858 -5883 FAX: 503 - 254 -8126 FEES Quantity Description Date Amount 1 cr1 Branch Circuits wo /Purchase 01/04/2011 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 01/04/2011 $6.74 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $62.92 Required Items and Reports (Conditions) This permitJs ssued subject • he 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 appro -d .fans. This permit will expire if work is not started within 180 days of ' - - •ce, or if work is suspended for more the 180 days. TTENTION: Oregon law e - ou to follow the rules adopted by the Oregon Utility Notifi• -tion C-nter. Thos 0' are set forth in OAR - 952 -0 1 -0010 thro gh OAR 952 5 ::: -0 • • ' ou ' ay obtain a copy • • he rules or direct questions to OUNC by calling ` r 3.. . 987-or 1.800. 32.2344. / a / / ` �l/ Iss d By: Permittee Signature: ' 1 . • , _ 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: 1 t • 1 l LICENSE NO.p6 ()S 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 Application FOR OFFICE [SE ONLY Tigard of Ti City RECEIVE n_, `.1 g CEl � L I' DateB Recei "ea � ©� �% Permit ��.eOWt7 1 Pl • 13125 SW Hall Blvd., Tigard, OR 97223 an Revie 11 Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit: My r,paro Inspection Line: 503.639.4175 JAN 0 4 2 Il Date Ready/By: tuns. la See Page 2 for I' I G A R D N otified/Method: Supplemental www.tigard or.gov pp lemental Information TYPE OF WO ITY OF TIGARD PLAN REVIEW ❑ New construction Addition/alteratio r m mee nIVISION 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 Jai t - 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 ❑mergency system. larger separately derived system. ['Addition of new motor load of ❑ "A ", "E ", "1 -2", "I -3 ", Job no.: Job site address: / Q'] lOOHP or more. occupancy. ' 1 tJ 1 F».. i.r �� , ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/Z1P: 0 Health -care facilities. ❑ Supply voltage for more than 600 volts nominal. T� rr s ❑ Ha zardous locations. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total I 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 Limited energy, multi - family 75.00 2 \ S 4.1. 1 t Pia residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER ❑ 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 relocation Temporary services or feeders installation, alteration, and/or City/State/ZIP: 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 1 56.18 �� I 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 r 67.84 2 E - mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited -energy Business name: f ,� panel, alteration, or extension. Page 2 2 A 7 Q e f- t ' ' C lC- Each additional inspection over allowable in any of the above , ` Address: 5c ' A. S' C / ��tn, h `` t l 2_1 k (. Additional inspection (1 hr min) 66.25/ hr Investigation (1 hr min) 66.25/ hr City/State /ZIP: r � I 0 cI Industrial plant (1 hr min) 78.18/ hr is Phone: (5p3) a+ OO 1 s Fa x: (so 3) 2_9_1 ^ gl 'Z Tp Inspections 'orwhich n is 90.00 /hr specifically listed (K min) CCB Lic.: n- 2.2_ El • moo.- 23c Suprv. Lic.: 2_,( ELECTRICAL PERMIT FEES Suprv. Electrician signature, requir Subtotal: S (n . 1 Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): G 7 ■ GIL 0C---1,■ 3 4.3---c-- TOTAL PERMIT FEE: co Z . i 2 Authorized signature: This permit application expires if a permit is not obtained within 180 Print name: � days after it has been accepted as complete. Date: Electrical Permit Application FOR OFFICE USE ONLY City of Tigard ��" -+,� Dat N�MMI ' ��,/ ' ' . • 13125 SW Hall Blvd., Tigard, OR 97223 1 b Plan Review Phone: 503.718.2439 Fax: 503.598.19 Date/B : Other Permit: f I G n It D Inspection Line: 503.639.4175 O r 201 Date Ready/By: ® See Page 2 for Internet: www.tigard - or.gov SAN Notified/Method: Supplemental Information TYPE OF WORK OF'�GAKp PLAN REVIEW El New construction ❑ Addition/alteration V 5N IJIO Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Demolition El Other: B ��UJJJ ► ► ►[LLLL ❑ 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 INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: Job site address: 100HP or more. Occupancy. ❑ 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: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I OM I Fee. I Total I • 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 Limited energy, multi - family 75.00 2 6 c d / t J — G- ,C � ` r, p�__ 1 e residential (with above sq. ft.) _ " "'� l.�J �` T 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 2 401 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 City/State/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 l 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 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 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 V Business name: panel, alteration, or extension. ( Page2 ) 2 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: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr specifically listed ('A hr min) CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEE S Suprv. Electrician signature, required: Subtotal: -7 Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): l'. 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. Print name: (' NQ,_ 6+,1-1)c. Date: (— S --- I ( • Number of inspections allowed per permit. t:\ Building \Permits\ELC- PermitApp.doc 07/01/10 44046151'(11/05/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 ork 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* ❑ 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 I: \ Building \Permits\ELC- PennitApp.doc 07/01/10