Permit n CITY OF TIGARD ELECTRICAL PERMIT
11 1 z CO MMUNITY DEVELOPMENT Pe rmit #: ELC2011 00032
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/13/2011
TIGARD 13125 2S104ACO2700
Jurisdiction: Tigard
Site address: 12550 SW 134TH AVE
Project: Wilde Subdivision: MORNING HILL NO. 8 Lot: 171
Project Description: (1) branch circuit for energy management device. Investigative fee required and paid.
Contractor: FRAHLER ELECTRIC CO Owner: WILDE, ERIN DANIELLE
11860 SW GREENBURG RD 12550 SW 134TH
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 639 -4627 PHONE:
FAX: 503 - 639 -4673
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 01/13/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/13/2011 $6.74
Type of Use: SF Electrical
Class of Work: ALT 56 Investigation Fee (Equals 01/13/2011 $56.18
Permit Fee)
Type of Const: 1 ea Investigation 12% Surcharge 01/13/2011 $6.74
Occupancy Grp:
Total $125.84
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 acc• • - .: . h 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. ATT. tTION: Oregon requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0 10 thro gh OAR 952- 001 - s • :. u ' ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issue. By: I , .. ' . Permittee Signature:, . :•. ' /.1 i5��a
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' -.110_, , , - �� tifsir cV___�
LICENSE NO. Date: 11
G� J/
5/ /•' 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 Applicati ! . C EIVED FOR OFFICE USE ONLI'
Received
71 Per mit No.:
City of Tigard DDate/By: �� �� j ,// - ?�
13125 SW Hall Blvd., Tigard, OR 97223 nn 11 1 Plan Review
Phone: 503.639.4171 Fax: 503.598.1,�.�0' ••I- 3 (-- Date/By: OtherPennit:
T I CARD Inspection Line: 503.639.4175 Dn Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov CIS Y OF TIGtti J *, Notified/Method: Supplemental Information .
„ < ,� NG D I I I I SIQ q e g: r,.y s a ky v
Vii::::: i r \N 1 � TYPE O I '. 4 .''� 'et N a xPLANT.AFLVIEVI�'y�" M.. 0t 1 .
.,. ; n. �, �:� _. e .� .... �'" . , ., . }' .. �. ... . }a 3 to x .'w + 5 ��'„ . s.t,., . . ,.,�. _ •,
❑ New construction ® Addition /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 t c 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
_ „, ❑ Emergency system. larger separately derived system.
JOB` S ITE INFORMATION AN D _LOCATdON ,41',
,;. - ... .,,, ........ , -; ,> . ... .. ❑ Add of new motor load of "A > " "1 -2 „ "1 -3 „
100HP or more. occupancy. .
Job no.: 66753 Job site address: 12550 SW 134th AVENUE ❑ Six or 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.: Project name: ADULT CARE FACILITY ❑ Service or feeder 600 amps or more.
. _ , alni , 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
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential
lr `, , �; P x t, DESCRIPTION OF WORK," `�'o # ns: (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
INSTALL PGWERWORKS ENERGY MANAGEMENT DEVICE INTO residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
ELECTRICAL PANEL AND INVESTIGATIVE FEES 200 amps or less 100.70 2
. ', , ; ®5PROPERTY OWNER i n ` v ` r z `r �; -.TENANT u , a 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
n 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
g ' r „, ❑ vAPPLICANT , ) s 0 - R CONTACTwEERSON i above service or feeder fee, 7 42 2
.. each branch circuit
Business name: B. Fee for branch circuits without , t 56.141
service or. feeder fee, first ry 56.18 142_,-36. 2
Contact name: branch circuit
Each add', 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
Email
Sign or outline lighting 67.84 2
. �x t �GONTRACTOR �w
v
4f,.. „,.:.' t,. , , :. Signal circuit(s) or limited- energy
Business name: . panel, alteration, or extension. Page 2 2
FRAHLER ELECTRIC COMPANY Each additional inspection over allowable in any of the above
Address: 11860 SW GRFFNBURG ROAD Additional inspection (1 hr min) . 66.25/hr
City /State /ZIP: TIGARD, Indust OR 97223
Investigation
plant ( 1 hr mm) 78.28/ hr
ri plt 1 min) 78.18/ hr
Phone: ( 503 639 -4627 Fax: (503 ) 639 -4673 Inspections for which no fee is
specifically listed (/2 hr min) 90.00 / hr
CCB Lic.: 37410 Electrical Lic.: 34 -13C Suprv. Lic.: 5110S ° , ri ,.x .: ; ELECTRICAL PERMVItT F,EES.
Suprv. Electrician signature, required:
subtotal: 112.36
�z G� Plan review (25% of permit fee):
Print name: ADAM ETHERINGTON Date: 01/13/11 State surchar (12% of p fee): 26.98 •
TOTAL PERMIT FEE: 139.34
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
1:\ Building \Permits\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:
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:
COMMERCIAM *00. 1$10 v , f,
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- PermitApp.doe 07/01/10