Permit CITY OF TIGARD ELECTRICAL PERMIT
s , COMMUNITY DEVELOPMENT Permit #: ELC2009 -00369
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/24/2009
Parcel: 25111 BD00411
Jurisdiction: Tigard
Site address: 14965 SW 96TH AVE
Subdivision: DARMEL NO. 3 Lot: 31
Project: Zenzano
Project Description: Panel change
Owner: FEES
ZENZANO, NELSON & Quantity Description Date Amount
KIMBERLY, 14965 SW 96TH AVE
TIGARD, OR 97224 1 ea Services or Feeders - 200 07/24/2009 $80.30
amps or less
PHONE: 1 ea 12% State Surcharge - 07/24/2009 $9.64
Electrical
Contractor:
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $89.94
Required Items and Reports (Conditions)
This permit is ' - ct to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ' accordance with .+•roved •lans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. • ENTION: Oregon law . - •uir= you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0• -0010 through OAR 952 -00 - 1100. ou a obtain a copy of the rules or direct questions to OUNC by calling 50 246.6699 or 1.800.332,2344.
/ ,,
Iss • d By: Permittee Signature: A& ►m_ �. __A
OWNER INSTALLATION ONLY
The installation is being made on p perty I own which is not intended for sale, lease or rent. '� /
OWNER'S SIGNATURE �l .Y1�M Dater < r� ' v.0C)1 CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 City Application FOR OFFICE USE ONLY
`J g Date/By: 7 a 7 el Es.e � 6 36y
Ci o f Tigard Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
ME Inspection Line: 503.639.4175 Date Ready/By: Jun fd See Page 2 for
Internet: www.tigard or.gov Notified/Method: /Q, Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction El Addition/alteration/replacement Please check all that apply (submit I 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
❑ 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: 1 q 1 . a I OOHPormore. occupancy.
1 � l � V. J 1 �V Q _ ❑ S i x or more res un ❑ Recreational vehicle parks.
City/State /ZIP: � �.� O � 9— a�Lf El Health-care facilities.
0 Supply voltage for more than
El Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 7 ef\Z Q..r( ) ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total l
New residential single- or m ulti - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK r (with above sq. ft.) 75.00 2
Limited energy, multi - family 75 00 2
Q r O ' t Y 1 residential (with above sq. ft.)
��'lll Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 'Q. 2
PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: Z r' ? �ln 401 amps to 600 amps 160.60 2
` C:\ y,, 601 amps to 1,000 amps 240.60 2
Address: \� � g t ),.... ) C\ 1- - D ,Q J Over 1,000 amps or volts 454.65 2
City/State /ZIP:"" Q 0 \._ l� ao- 4 Temporary services or feeders installation, alteration, and /or
■ relocation
Phone: \ D � -- -1 Fax: ( ) 200 amps or less 66.85 1
Owner installation* This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, le , e, rent, or exchang • according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
signa t Branch circuits - new, alteration, or extension, per panel
Owner si
g ,, r! " \\, s, . L , y r f _∎ Date " a •� A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
•
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
ONTRACTOR Sign or outline ligllting 53.40 2
•
Signal circuit(s) or limited -
Business name: energy panel, alteratioi or
Address: extension. Describe: Page 2 2
City/State /ZIP: (i-..../".
Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( )
Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: _ gQ. �X)
Print name: Date: Plan review (25% of permit fee): <0
State surcharge (12% of permit fee): 4-69'
Authorized si Ina tK1\ r-.. Z� �� TOTAL PERMIT FEE: czci ?Li
t , This permit application expires if a permit is not obtained within 180
Print name: 1 ,. is • t Date: • v days after it has been accepted as complete.
" Number of inspections allowed per permit.
I:\ Building \PermitsELC- PermitApp.doc 05/23/06 440- 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
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
I I HVAC
❑ Instrumentation
n 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
1:\Building\Permits\ELC- PermitApp.doe 03/23/06