Permit CITY OF TIGARD J EI , ED ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT /'?. // Permit #: ELC2011 -00052
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/21/2011
Parcel: 2S111DC12700
Jurisdiction: Tigard
Site address: 15960 SW OAK MEADOW LN
Project: STONEKING Subdivision: Lot: 0
Project Description: Fire repair to panel, (1) panel and (3) branch circuits. 1/25/11, reprint to add (10) additional branch circuits.
Contractor: VAST ELECTRIC Owner: STONEKING, GERALDINE
1525 SEATTLE SLEW DR. SE 15960 SW OAK MEADOW LN
SALEM, OR 97301 TIGARD, OR 97224
PHONE: 503 - 566 -7274
PHONE: 503 - 636 -6611
FAX: 503 - 585 -8828
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 01/21/2011 $100.70
Specifics: amps or less
3 crt Branch Circuits w /Purchase 01/21/2011 $22.26
Type of Use: SF Service br Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 01/21/2011 $14.76
Electrical
Type of Const: 10 crt Branch Circuits w /Purchase 01/26/2011 $74.20
Occupancy Grp: Service or Feeder
0 ea 12% State Surcharge - 01/26/2011 $8.90
Electrical
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 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. ATTE •N: Ore••n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -00 . through OAR •5 :. 0.90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.$00.332.2344.
/ e •
Issued B Perm ittee Signature:
OWNER INSTALLATION ONLY (J
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.
•
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00052
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/21/2011
Parcel: 2S111DC12700
Jurisdiction: Tigard
Site address: 15960 SW OAK MEADOW LN
Project: STONEKING Subdivision: Lot: 0
Project Description: Fire repair to panel, (1) panel and (3) branch circuits.
Contractor: VAST ELECTRIC Owner: STONEKING, GERALDINE
1525 SEATTLE SLEW DR. SE 15960 SW OAK MEADOW LN
SALEM, OR 97301 TIGARD, OR 97224
PHONE: 503 - 566 -7274
PHONE: 503 - 636 -6611
FAX: 503 - 585 -8828
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 01/21/2011 $100.70
Specifics: amps or less
3 crt Branch Circuits w /Purchase 01/21/2011 $22.26
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 01/21/2011 $14.76
Electrical
Type of Const:
Occupancy Grp:
Total $137.72
Required Items and Reports (Conditions)
This permi issued subjec • the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don_ in accordance with appr• ed : ans. 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 r •u o follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -r 01 -0010 thro OAR 952-001(00 !0. •u ' -y obtain a copy of the ru or direct questions to OUNC by calling 503.23_ • • -r 1.800.33
Is ued By: � 4 .t-C/l���l /'�-� /� Permittee Signature:
g - / Ti �
t Si 9�5�✓ �� -
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:
O I CTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date: � /
J/j
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 Application FOR OFFICE USE ONLY . •
City of Tigard \\.44,' D irl[l1 m� i % Permit No.: 2$11=03= ELCI'D//r a
13125 SW Han Blvd., Tigard, OR 97223 , Plan R
t 4 . Phone: 501718.2439 Fax: 503.598.1960 ` - � other Permit:
T I G A f Internet Inspection Line: 503.639.4175 6g 5 1� 1- Date Ready,By: Jw;s E1 See Page 2 for
Internet www.tigard-or.gov \P\v ( hotified'Method: Supplemental Information
,._ rz+
TYPE OF WORK
....-.1 �� \ \ l�c�OSs PLAN REVIEW
t .,r v % t't ' Please check all th apply submit 2 sets of plans wlitems checked below
El New construction ® Addition /alteration/replacement ItAG p y ( P )
❑ Demolition El Other: (�` � V O Service or feeder400 amps or more ❑ Building over three stori
p�+ 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 ❑ Commercialiindustrial ❑ Accessory building amps for all other installations. buildings.
0 Multi- family [] Master builder El Other: ['Fire pump. ❑ Installation of75KVAor
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION El Addition of new motor toad of ❑ A ", "E", '1 -2 ". `'t -3 ",
1
i Job no.: Job site address: 15960 SW Oak Meadow Lane IOOHP o more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
CityiState /Z1 P: Tigard Or ❑ Health -care facilities. ❑ Supply voltage for more than
❑ l laaardoas locations. 600 volts nominal,
Suite/bldg, /apt no.: Project name: Stoneking ❑ Set }ice or feeder 600 amps or more.
FEE SCHEDULE
Cross streetldirections to job site:
J Description I Qtr. I tee. [ Total [
New residential single- or multi- family dwelling unit.
_ Includes attached garage.
Subdivision: — 1 Lot no.: Loot) sq. ft. or less 165.54 4
Ea. add'] 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
Need to add 10 circuits per inspectors request. residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
0 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 j
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) , Fax: ( ) 200 amps or less 59.36 t
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 l 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. For for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, I D 7 4� 74.20 i
2
each branch circuit
Business name: B. Fee for branch circuits without 1
service or feeder fee, first
Contact name: 56.18 12
branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each,manufactured or modular
dwelling, service and/or feeder 67.84 2
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) nr limited- energy
Business name: Vast Electric, Inc. panel alteration, or extension_ Paget 2
Each additional inspection overallowa in any of the above
Address: 1525 Seattle Slew DR SE Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Salem, OR 97317 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.181 hr
Phone: (503) 780 - 8597 Fax: (503) 585 - 8828 Inspections for which no fee is
specifically listed (14 hr min) 90.001 hr
CCB Lie.: 175531 Electrical Lie.: C -280 Suprv. Lic.: 5186S ELECTRICAL PERMIT FEES
Suprv_ Electrician signature, required: 76<-..,___ Ji Subtotal: 74.20
P q L __ -` Plan review (25% of permit fee):
. Print name: Tim Vander Stoep Date: 01/25/11 State surcharge (12% of permit fee): 8.90
TOTAL PERMIT FEE: 83.10
Authorized Signature: This permit application expires if a permit is not obtained within 1
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
Ll no ■Perrnits \ELC-PennaApp.dcc 07;01'10 440- 4615T( I I/05 OsVWED
Z 8Z88 989 'out o1l10813 Isen d81.40 1.1. 9Z uer
Electrical Permit Application RECEIVED FOR OFFICE USE ONLY
City of Tigard
13125 SW Hall Blvd.,
JAN 2 1 ?1 i Received ��a G � ! � �
V D ate /B : ( ., Ti g ard, OR 97223
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960G.I.r+ l i � OF TIGARD Date/B Permit No.: Other Permit:
TI G A R D inspection Line: 503.639.4175 Date Ready /By: Suns: ® See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISIOI Notified/Method: Supplemental information
TYPE OF WORK PLAN REVIEW
❑ New construction Z dition/alteration /replacement 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
I- 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
El Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ",
100HP or more. occupancy.
Job no.: Job site address: r I�5166 ltj
•
„ t i
0 Six or more residential units. 0 Recreational vehicle parks.
City /State /ZIP: oi 7
1 7 d f7` I ❑ Health -care facilities. ❑ Supply voltage for more than
19 tr r ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: J Project name: s��, 0e k fie ❑ Service or feeder 600 amps or more.
4 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'l 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
pa N P C f ' - a it , -ct r e ,re pc. r residential (with above sq. ft.)
c�/t \ Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100.70 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
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
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 I 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'l 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
If — / panel, alteration, or extension. Page 2 2
Business name:
Vol I r F -✓' IC r • Each additional inspection over allowable in any of the above
Address: t S a 3- Sect /fk ( r E Additional inspection (1 hr min) 66.25/ hr
investigation (1 hr min) 66.25/ hr
City/State /ZIP: le twt old G 73 i 7 Industrial plant (1 hr min) 78.18/ hr
Phone: (6 6d _ 74 -? l.i Fax: (5p3 ) 75 - g-e-d-g- inspections for which no fee is 90.00 / hr
_ specifically listed Ch hr min)
CCB Lic.: 1.73 -3,3 t Electrical Lic.:—'7 Suprv. Lic.:,`J ('6 5 ELECTRICAL PERMIT FEES
Suprv. Electrici ' ature, re 'red: ` / 1 Subtotal:
r t 1 ///(�er 5��°P Plan review (25% of permit fee):
Print name. � ,� ��
Date: State surcharge (12% of permit fee):
TOTAL PERMIT FEE: /g
Authorized *gnature: 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.
:\ BuildinglPermits \ELC- PermitApp.doc 07/01/10 440- 4615T(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 of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
Fl HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
P\ Building \Permits\ELC- PermitApp.doc 07/01/10