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Permit
1 a CITY OF TIGARD j ELECTRICAL PERMIT 1 2 COMMUNITY DEVELOPMENT ©$ // . Permit #: ELC2011 -00079 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/02/2011 Parcel: 2S 103BA00111 Jurisdiction: Tigard Site address: 12005 SW ANN ST Project: Pugh Subdivision: LERON HEIGHTS Lot: 11 Project Description: Panel replacement. 2/8/11, reprinted to add (1) branch circuit. Contractor: FRAHLER ELECTRIC CO Owner: PUGH, THOMAS R AND BARBARA J 11860 SW GREENBURG RD 12005 SW ANN ST TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503 - 639 -4627 PHONE: FAX: 503 - 639 -4673 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 02/02/2011 $100.70 Specifics: amps or less 1 ea 12% State Surcharge - 02/02/2011 $12.08 Type of Use: SF Electrical Class of Work: ALT 1 crt Branch Circuits w /Purchase 02/08/2011 $7.42 Service or Feeder Type of Const: 0 ea 12% State Surcharge - 02/08/2011 $0.89 Occupancy Grp: Electrical Total $121.09 Required Items and Reports (Conditions) This permit is iss -- -- 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 - ordance 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. AT NTION: Oregon law req ' - - to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-%010 thro •h OAR 952 -001 r • 0. Y , ay obtain a cop of the rules or direct questions to OUNC • ,.• �- .1987 or 1.800.382.2344. Issue By: Permittee Sign: ,• . .� - _ / 4 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. ELEL � 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 TIG ELECTRICAL PERMIT `F'1 COMMUNITY DEVELOPM Permit #: ELC2011 00079 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/02/2011 Parcel: 2S103BA00111 Jurisdiction: Tigard Site address: 12005 SW ANN ST Project: Pugh Subdivision: LERON HEIGHTS Lot: 11 Project Description: Panel replacement. Contractor: FRAHLER ELECTRIC CO Owner: PUGH, THOMAS R AND BARBARA J 11860 SW GREENBURG RD 12005 SW ANN ST TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503 - 639 -4627 PHONE: FAX: 503 - 639 -4673 • FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 02/02/2011 $100.70 Specifics: amps or less 1 ea 12% State Surcharge - 02/02/2011 $12.08 Type of Use: SF Electrical 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 work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted bathe Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through • ^ * - 001 -0090. You may • • . ..'•py o e ru e-. direct ques •ns to OUNC by calling 503.232.19.800.33 0.44. Issued B • /- — —�,.r •ermittee Signature: '� J 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. Electrical Permit Application FOR OFFICE USE ONLY City of Tigard Received Date /B a� nff9� PenrFT�d� �r� • , —,,, • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review _ • Phone: 503.718.2439 Fax: 503.598.1960 Date /B : Other Permit: T I GAR 1J Inspection Line: 503.639.4175 Date Ready /By: luris: H 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 2 sets of plans w /items checked below): ❑ Demolition ❑ Service or feeder 400 amps or more ❑ Building over three stones. ❑ O ther: 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: El Fire pump. 0 Installation of75 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -Y', "1 -3 ", Job no.: 68206 Job site address: 12005 SW ANN STREET I00HP or more. occupancy. ❑ 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.: I Project name: PUGH RESIDENCE ❑ Service or feeder 600 amps or more. Cross street/directions to job site: FEE SCHEDULE Description i Qty. I Fee. 1 Total I New residential single- or multi - family dwelling unit. Includes attached garage. I I Subdivision: Lot no.: 1,000 sq. ft. or less 1 168.54 1 4 Tax map /parcel no.: Ea. add'( 500 sq. ft. or portion 33.92 1 Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family INSTALL EXTERIOR LIGHT residential (with above sq. ft.) 75.00 2 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 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 _relocation Phone: ( ) Fax: ( ) 200 amps or less � — 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 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 L ❑ CONTACT PERSON above service or feeder fee, 1 7 42 7.42 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 Contact name: branch circuit 2 Address: Each add'I branch circuit 7.42 2 Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular I 67.84 1 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 E - mail: Pump or irrigation circle 67.84 2 Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited - energy Business name: FRAHLER ELECTRIC COMPANY panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: 11860 SW GREENBURG ROAD Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: TIGARD, OR 97223 Investigation (1hrmin) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: (503 ) 639 -4627 Fax: ( 503) 639 -4673 Inspections for which no fee is specifically listed W. hr min) 90.00 / hr CCB Lic.: 37410 Electrical Lic�: 34 -13 Suprv. Lie.: 511OS ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: G % �� ' � 'r ( Subtotal: 7.42 Plan review (25% of permit fee): Print name: ADAM ETHERINGTON Date: 02/04/11 State surcharge (12% of permit fee): . 89 Authorized signature: Lid TOTAL PERMIT FEE: 8.31 Thi 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: 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 El Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems E l Landscape Irrigation Control* El 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.doc 07 /0l /10 Electrical Permit Application nn FOR OFFICE USE ONLY City of Tigard Cel ' v Received Date/B : A� Permit No.: �• _ - _ - • 13125 SW Hall Blvd., Tigard, OR 972 I ` Phone: 503,718.2439 Fax: 503.598.1960 Plan Review C Date /By: Other Permit TIGARD Inspection Line: 503.639.4175 8 o D ate Read /B G y y' . � WI See Page 2 for Internet: www.tigard- or.gov ` '`�CIARvi Notified/Method: / ply Supplemental Information TYPE OF WORCtN `Q } Pt�1Si • PLAN REVIEW ❑ New construction ® Addition /alteratiltic'Fment Please check all that apply (submit 2 sets of plans w /items checked below). ❑ Demo ion ❑Other: ❑ Service or feeder 400 amps or more El 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. 1 - and 2 - family dwelling c ommercial /industrial ❑Accessory buildin less to ground, or exceeds 14,000 ❑ Commercial -use agricultural g amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: 1:3 Fire pump. ❑ Installation of75 KVA or JOB SITE INFORMATION AND LOCATION ID Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: 68206 Job site addr ess: 12005 SW ANN STREET 100HP or more occupancy. ❑ 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: PUGH RESIDENCE ❑ Service or feeder 600 amps or more. Cross street/directions to job site: FEE SCHEDULE Description Qty. 1 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'l 500 sq. ft. or portion 33.92 1 Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi - family 75.00 2 REPLACE ELECTRICAL PANEL residential (with above sq. ft.) Services or feeders installation, alteration, and /or relocation 200 amps or less 1 100.70 100.70 2 ❑ PROPERTY OWNER ❑ TENANT 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 relocation • Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 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 Contact name: branch circuit 56.18 2 Address: Each add'] branch circuit 7.42 2 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 E Pump or irrigation circle 67.84 2 Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited - energy Business name: FRAITLER ELECtRIC COMPANY panel, alteration, or extension. _ Page 2 2 Each additional inspection over allowable in any of the abov Address: 11860 SW GREENBURG ROAD Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: TIGARD, OR 97223 Investigation (] hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: ( 503) 639 -4627 Fax: (503 ) 639 -4673 Inspections for which no fee is specifically listed (%S hr min) 90.00/ hr CCB Lic.: 37410 Electrical Lic.: 34 -13C Suprv. Lic.: 5110S _ ELECTRICAL PERMIT FEES Suprv. Electrician signature, retb red Subtotal: 100, 70 Plan review (25% of permit fee): Print name: ADAM ETHERINGTON Date: 02/01/11 State surcharge (12% of permit fee): 12.08 Authorized signature: TOTAL PERMIT FEE: 112.78 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. I:\ Building \Permits\ELC- PermitApp.doe 07/01/10 440- 4615T(1 I /05 /COM/WEB