Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00322
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/14/2011
Parcel: 2S103DD00300
Jurisdiction: Tigard
Site address: 13570 SW WATKINS AVE
Project: Ramirez Subdivision: MELROSE Lot: 3
Project Description: Rewire garage.
Contractor: VAST ELECTRIC Owner: RAMIREZ, KEVIN P & LEEANNE M
1525 SEATTLE SLEW DR. SE 13570 SW WATKINS AVE
SALEM, OR 97301 TIGARD, OR 97223
PHONE: 503 - 566 -7274 PHONE:
FAX: 503 - 585 -8828
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 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 in -- ordance with •roved 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. ATT. TION: Oregon law req ' -s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules set forth in OAR
952 - 001 -00 0 throug OAR 952 -001 -1 • •0. You •btain a copy of the rules or direct questions to OUNC by calling 03.2 2. _/
Issued : ` `/ - 4% Permittee Signature: /! 2Llt✓
• 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:
TRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' 10 1 1W l /. /: " Date: - I,
LICENSE NO. ' 51 e 5
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 Applicati Ec
.L i 9 F a FOR OFFICE USE ONLY
of Tigard p� 1 4 v `
City g Received . / , / Permit No.: ELe owl DO) .2Z
,
° 13125 SW Hall Blvd., Tigard, OR 9722 JUN 1 2011 Date/By: CO 11 1l Plan Review
M •Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
[ IGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov BUILDING Di'ViSiCM`•i Notified/Method: Supplemental information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction p Addition/alteration /replacement
❑ 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.
,�1L ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 1 35 ir✓. Wrs
70 StT k Aie or more. occupancy.
I h S ❑ Six Six o or r more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: t J t� oR ❑ Health facilities. ❑ Supply voltage for more than
/ ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: P\ot ❑ Service or feeder 600 amps or more.
wt-I ✓ `e L
job site: FEE SCHEDULE
Cross street/directions to
J 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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family 75.00 2
P-ve- t r e_ J A J@ residential (with above sq. ft.)
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
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, 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 ' 56.18 2
Contact name: branch circuit
Each add'l branch circuit ( 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State /ZIP: dwelling, service and/or feeder
Phone: ( ) Fax: : ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
panel, alteration, or extension. Page 2 2
Business name:
Va5- E I ect(` tC vi r • Each additional inspection over allowable in any of the above
Address: I gas 5e g itie Sler,✓ Dr. Sf Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: 5 lt% ) O K . °► 1317 Investigation (1 hr min) 66.25/ h
Industrial plant (1 hr min) 78.18 / hr
Phone: (50 3) 566 _ 77 L1 Fax: (5 Q 3) 5 S5 - //q. Inspections for which no fee is 90.00 / hr
specifically listed ('A hr min)
CCB Lic.: 176 ( Electrical Lic.: g? 0 Suprv. Lie.: 5 186 5 ELECTRICAL PERMIT FEES /,
Suprv. Electrician signature, required: l i � - " �/
Subtotal: (as . & _ r ?•H r Plan review (25% permit fee):
Print name: i i tM VA N )e.r t Date: State surcharge (12% of permit fee): - 1 . Co S TOTAL PERMIT FEE: A S
Authorized signature: 1
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(l1/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for Al residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ 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
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
F7 Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n 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 07/01/10