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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00113 Date Issued: 03/01/2011 T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 1S133D610000 Jurisdiction: TIGARD Site address: 11314 SW EUCALYPTUS PL Project: Taylor Subdivision: Lot: 0 Project Description: Reconnect only. Contractor: Owner: TAYLOR, PATRICIA 11314 SW EUCALYPTUS PL TIGARD, OR 97223 PHONE: PHONE: 503 - 504 -1897 FAX: FEES Quantity Description Date Amount 1 ea Reconnect Only 03/01/2011 $67.84 Specifics: 1 ea 12% State Surcharge - 03/01/2011 $8.14 Electrical Type of Use: SF Class of Work: OTR Type of Const: Occupancy Grp: Total $75.98 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 ON: Orego law re 'res you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00 through OAR 952 - 090. YgCmay obtain � a rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By. ' iC j(x Permittee Signature: 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. Electrical Permit ApplicationRECEIVED Received „ City of Tigard R - DateBy: ` h Permit No.: a7 `� �! l 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Permit: T I G A R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: VI See Page 2 for Internet: www.tigard - or.gov BUILDING DIVISION 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): ❑ 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 Ell- 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: //3/1:7 t� 100HP or more. occupancy. u GAIL �TL�l,�7 �l�« ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: -1--; h� ['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: C j c iA 01 ( 5 F ,O r r Description I Qty. I Fee. I Total I • 5 ` C� - o \l o wes © ` o f Q CST r- New residential single - or multi - family dwelling unit. �n I� l l� Includes attached garage. Subdivision: u_„ ,e,rwlaock vI I I 1 Lot no.: 1,000 sq. ft. or less 168.54 4 Tax map /parcel no.: e, 0 t n CO k a ©-F- s-r e_et Li Limited 500 y, es ft. or portion 33.92 1 r Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi- family V WI l-6 . r i A o D iI residential (with above sq. ft.) 75.00 2 cal. .-� 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 Name: ?�r 6 G I a..... ( 1'. 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: I O 34- S t 1 \/ BO n i e. N.4 e � ©uj L h , Over 1,000 amps or volts 552.26 2 n� '^ Y � Temporary services or feeders installation, alteration, and /or City/State /ZIP: to I `a ` n R e -! / o 0 Co relocation Phone: ( 503 ) 50 t. J. _, I g 9 7 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 t 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 1 ❑ 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 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only x 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 C' / CTOR Signal circuit(s) or limited- energy Business name: panel, alteration, or extension. Page 2 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 (%z hr min) CCB Lic.: Electrical Lie.: Suprv. Lic.: ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): TOTAL PERMIT FEE: 75 i ft Authorized signature: y��/If� , f ,�}2 This permit application expires if a permit is not obtained within 180 Print name: V 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* lEr Other: 0 Yx. ,t &2`L t o MAUL - .ovi ©rn Lecam`I Gl 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 1 : \ Building \Permits\ELC- PermitApp.doc 07/01/10