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Permit
CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00125 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/08/2011 Parcel: 2S102AB00904 Jurisdiction: Tigard Site address: 12050 SW LINCOLN AVE Project: OROZCO Subdivision: KIMBERLY ADDITION Lot: 4 Project Description: Replacing service. Contractor: OWNER Owner: OROZCO, ENRIQUE & CASTRO, ALICIA AGUILAR 9375 SW STONO DR TUALATIN, OR 97062 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 03/08/2011 $100.70 Specifics: amps or less 2 crt Branch Circuits w /Purchase 03/08/2011 $14.84 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12% State Surcharge - 03/08/2011 $13.86 Electrical Type of Const: Occupancy Grp: Total $129.40 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 by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through • 'a': - 001 -0090. You may obtain a copy of - - qr direct questions to OUNC by calling 32.1987 or 1.800.332.2344. Issued By: /`iit / - Permittee Signature: k2 n/Y' zCO 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 Application VD FOR OFFICE USE ONLY City Tigard Tl d � I RECC1 Date/B : �r Permit No.: vvv � tJ • 13125 SW Hall Blvd., Tigard, OR 972 ' 3 Phone: 503.718.2439 Fax: 503.598.1960 „„ $ 7 1 Plan Review Date/By: Permit: T I G A R D Inspection Line: 503.639.4175 ? Date Ready/By: hiris: H See Page 2 for Internet: www.tigard or.gov S Il otified/Method: 03_ Supplemental Information TYPE OF WORK \ I. vAcj),.. PLAN REVIEW Al ❑ New construction - Mddition/alteratiolOaginent 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 VI 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 ", z (J 5 U r ' IOOHPormore. occupancy. Job no.: Job site address: I > ua) 1 1 (--- ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: c ❑ Supply volts ❑ Heal -care facilities. pp y ge for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: U ZCC5 ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: O W - Oc C4.- 40 J C J Description I on. 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'l 500 sq. ft. or portion 33.92 1 Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) ^� , ll \ Limited energy, multi- family 75.00 2 ___4_, N A^'?< \ \ v 0 • S� V \i ` e residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less I 100.70 'v t 70 2 to PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: ,u kl..„'p tr z. Oiteisue. 601 amps to 1,000 amps 301.04 2 Address: \ Z 0 s O S L ` rt./ c_, (,, 0,, , Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and /or City/State /ZIP: 1- \ 5 ✓N ( D kg • relocation Phone: (S a3) 24 ' 2 St .S_ Fax: ( _T 200 amps or less 59.36 201 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 168.54 2 intended for sale, lepses rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, per panel Owner signature: hap/� A1/4, Or Date: 0 3 - -// A. Fee for branch circuits with ps APPLICANT I ❑CONTACT PERSON above service feeder fee, 7 42 el/ U 1 eQ each branch circuit Business name: c B. Fee for branch circuits without ---� t 2 Z el if ZO n 1_. k_L-1 service or feeder fee, first Contact name: L ,,,, `� e ms' (., branch circuit 56.18 2 Each add'l branch circuit 7.42 2 1 C Address: , - Z--Q S" c- La LC l•-i Gut hJ 't- Miscellaneous (service or feeder not included) City /State/ZIP: Each manufactured or modular 67.84 2 9 �� . dwelling, service and/or feeder - Phone: ( .') ) � Z 1 ? Z ki _s Fax: : (, )_ -r 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 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 ('A hr min) CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: f S Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): / 3 , Authorized signature: TOTAL PERMIT FEE: f)-1, 4 ,0 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.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* n Burglar Alarm n Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* I 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 n Boiler Controls ❑ Clock Systems n Data Telecommunication Installation n Fire Alarm Installation n HVAC n Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* n Medical n 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: 07/01/10 Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. i7 9 e 3J-, . CYO ZCC' Print Nam6 of Permit Applicant C_;7 .c ) . ©r() c o 03 o 9' // Signature of Permit Applicant Date Permit #: - 1- c.-Al 1 1-Odo -s 0-CAS , itd . 4 hicdl l / �% Address: .: -7'1 ,., ' q7»5 Issued by: e.-- Date: 3/0/ This Copy for Permit Offices