Permit CITY OF TIGARD ELECTRICAL PERMIT
° - COMMUNITY DEVELOPMENT Permit #: ELC2011 -00375
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/06/2011
Parcel: 2S111BD00312
Jurisdiction: Tigard
Site address: 9940 SW PEMBROOK ST
Project: MCCARTHY Subdivision: Lot:
Project Description: Panel replacement.
Contractor: OAKLEY ELECTRIC INC Owner: MCCARTHY, MICHAEL D & JENNIFER E
12042 SE SUNNYSIDE RD STE 500 9940 SW PEMBROOK ST
CLACKAMAS, OR 97015 TIGARD, OR 97224
PHONE: 503 - 855 -4712 PHONE.
FAX: 503 - 855 -4723
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/06/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 07/06/2011 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 OA' .--;41-0090. You may obtain a copy of the r •ect questions to OUNC by calling 503.2987 or 1.800.332.2344.
Issued By:/ = 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 Applicati rdY,
Ci of Ti and ` 10'\\ Received •
`f g ` � DatefBy: )/, /i Permit No.!
' ' • 13125 SW Hall Blvd Ti OR 97223 � • t�'� f 11 - - 74-- 7 t „_ Pla Review
Phone: 503.718.2439 Fax: 503.598.1960 tt �r�l G Other permit:
S 1 G� ` Date By:
f 1 G i1 R D Inspection Line: 503.639,417 1v1 Date Ready/By: .turis: See Page 2 for
Internet: www.tigard- or.gov � C `1 1 ��1 �G� ( NotifiedIMethod: (3— -[Q Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ;Additionralteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Other: where the available fault current ❑ Marinas and boatyards.
. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
ICU to ground, or exceeds 14,000 ❑ Commercial -use agricultural
W- and 2- family dwelling ❑ Commercialiindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder p ❑ I nstallation of KVA or 7 5
❑O ilier: ❑ Fire pump. 75
❑ Emergency system. larger separately derived system.
JOB. SITE INI?ORMATION AND LOCATION
0 Addition of new motor load of ❑ "A", "E", "1-2", "1-3",
Job no.: Job site address: f� � 100HP or more. occupancy.
719(5 ...54.,/ c- %e* r 4" ❑ Six or more residential units. ['Recreational vehicle parks.
City/State /ZIP: // !t f 0 Health-care facilities. ❑ Supply voltage for more than
❑Haaudous locations. 600 volts nominal.
i Suite/bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street /directions to job site: Dmrrtpt;rra 1 Qr. 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.)
Limited energy, multi - family t 75.00 2
! qn-G/ C4 r. residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less / 100.70 /pr) 7d 2
0 PROPERTY OWNER l. I . 0 TENANT 201 amps to 400 amps 133.56 2
Name: amps to 600 amps 200.34 2
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 ]
Owner installation: This installation is being made an property that I own which is not 201 amps to 400 amps 125.08 2
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. FCC for branch circuits with
0 APPLICANT 0 CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit 56.18 2
Each add'I branch circuit 7.42 1 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
E - mail:
Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited -energy
Business name: ^ f / panel, alteration, or extension. P 2 2
s / A.k lei E � 4- f G Each additional inspection over allowable in any of the above • Address: J_2 sg s tinny 5/ yr. /P „/ s-�r ,4 sec, i Additional inspection (I lir min) 66.25/ hr
Cit)'iStateiZIP' ` Investigation (1 hr min) 66.25/ hr
C� . � `' f ` ,.. ' s Industrial plant (1 hr min) 78.18/ hr
Phone: { hr min) 5a3) S_ y7 /.r Fax: (54,3 ) 8'5 y 7.2 3 Inspections for which no fee is
1.. 7 � ` specifically listed (%z 90.00 / hr
CCB Lic.: Electrical Lic.:� Supra. Lie.:�r /7�j speci ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:
Subtotal: /CO 7 - 4 - - -
7 ,.......---- Plan review (25% of permit fee):
Print name: / r- a + s Arr Date: State surcharge (12% of permit fee): f a, Qg
Authorized signature: ���777 �^” TOTAL PERMIT FEE: ; p 1i
`� This permit application expires if a permit is not o led within 180
Print name: 7 , _ /. S ` r p— Date: days after it hes been accepted as complete
• Number of inspections allowed per permit.
L'd L60609L909 °u1 AelNe0 oLZ :60 H. 90 Inf