Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00324
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/14/2011
Parcel: 2S115AA04600
Jurisdiction: Tigard
Site address: 10827 SW CHATEAU LN
Project: TEMPLIN Subdivision: REBECCA PARK Lot: 3
Project Description: (2) branch circuits
Contractor: PRECISION NW ELECTRICAL Owner: TEMPLIN, RAYMOND JEROME
12020 SE ANNA CT 10827 SW CHATEAU LN
DAMASCUS, OR 97009 TIGARD, OR 97224
PHONE: 503 - 413 -9870 PHONE:
FAX: 503 - 594 -2873
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 06/14/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/14/2011 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 —i OAR
952- 001 -0010 through OAR 952- 001 -0090. You may otTuin a copy o - • • : •uestions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: A. �j
. W r . r _
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 � 0 FOR OFFICE USE ONLY
R eceived
City of Tigard Date/B : i /y iMt - Permit No.: .
' u 13125 SW Hall Blvd., Tigard, OR 97 3 % \\ Plan Review
Phone: 503.718.2439 Fax: 503.598.- '960 B
60 \ Other Permit:
� \\ Date
/B
I G A R D Inspection Line: 503.639 ,��\v t Date Ready/By: ® See Page 2 for
Internet: www.tigard- or.gov � t 043 Notified/Method: �` , Supplemental Information
TYPE OF WORK? 1 ya @ V � k t i Alk, " PLAN REVIEW
❑ New construction [ dition/alteratio fie FaCement 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
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
CI Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "l -3 ",
(r..� `� � - f (� ,, IOOHP or more. occupancy.
Job no.: Job site address:
V `� �W v /Y \ p! i �t 0 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: —1- ( S ,10 i CJr. 1` -L-Lz+ Lonvo js — ❑ Health -care facilities.
❑ Hazardous locations. ❑ Supply voltage for more than
600 volts nominal.
Suite /bldg. /apt. no.: Project name: , ❑ Service or feeder 600 amps or more.
tIN FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33 92 I
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
l CAS—Ar 3Fwc..)-- ,r" residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
0 kJ " C - SAN) l. , QA.)4r 1 -1- 200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
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
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, ter panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 1 ( 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first /f _ 56.18 GP - iP 2
Contact name: branch circuit �✓
Each add'l 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 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 nam .e (t .I L � [�5�•7! _ panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 0!Ls.)''ZQ 5 E Othrysh \3 .l , C—'Ir" Additional inspection (I hr min) 66.25/ hr
„ e_ ,A r cA) 3 1` )' 1 0 q
Investigation i plant (r min) 66.25/ hr
City /State /ZIP: 0
� to `' r9 v'� .7� `�/ �f' C i 7 0 `7 Industrial lant I hr min 78.18/ hr
Phone: ( /�� Fax: fit c ry Ins ctions for which no fee is
( �) 'i'l 3 ' _ _( �� (��) �1 �-r 2.ia� 90.00 / hr
specifically listed (Y2 hr min)
CCB Lie.:' t t ), C� , Electrical Lic.: 1 Suprv. Lic.: S 0 3 ka r ELECTRICAL PERMIT FEES
Subtotal: (,V3 -Cr()
Suprv. Electrician signature, required:
Plan review (25% of permit fee):
Print name: 1 ,,,,, ! Date: 25 4 State surcharge (12% of permit fee): - 7 • 6
`^'"u TOTAL PERMIT FEE: $7/ r O >
Authorized signatur
This permit application expires if a permit is not obtained within 180
Print name: �i (p1/4/da. Date: C *
days Lion it has been accepted as complete.
Number of inspections allowed per permit.
L'. 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:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n 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
n C • lock Systems
❑ Data Telecommunication Installation
n F ire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls ' ~
n O utdoor Landscape Lighting*
n P • rotective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \ Building \Permits\ELC- PermitApp.doc 07/01/10