Permit 'r q
CITY OF TIGARD ELECTRICAL PERMIT
- COMMUNITY DEVELOPMENT Permit #: ELC2011 -00380
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/08/2011
• Parcel: 2S112BD01700
Jurisdiction: Tigard
Site address: 15050 SW 79TH AVE
Project: PAR Subdivision: Lot:
Project Description: (4) branch circuits for kitchen remodel.
Contractor: CRAINIC ELECTRIC CO Owner: PARREIRA, DANE & KATHY
15812 SE BROOKLYN ST 15050 SW 79TH AVE
PORTLAND, OR 97236 TIGARD, OR 97224
PHONE: 503 - 913 -8005 PHONE:
FAX: 503 - 760 -1787
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 07/08/2011 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/08/2011 $9.41
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
Required Items and Reports (Conditions)
This per is e• • ='-ct to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be d e in accordance with - =•roved • ans. This permit will expire if work is not started within 180 days of issuance, or • . •rk is suspended for mor= he 180
da . ATTENTION: Oregon law re• ire• yo. to follow the rules adopted by the Oregon Utility Notification C= - ose rules are set f• in OAR
9 - 001 -0010 thr ugh OAR 952 -00 0090. You- obtain a copy of th rules or direct questions to OUNC by calling 503.2 • 1.800.44. t
ssued By: I .411" ` � � Permittee Signature: �� AA!
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' _ �� L � � i / �` 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 FOR OFFICE USE ONLY
City of Tigard DateB 7 � _ � Permit No.: ac.00l� �3gQ
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' : • Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
TIGARD Notified/Method: Supplemental www.tigard PP lementalInformation
TYPE OF WORK PLAN REVIEW
El 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 0 Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
- and 2- family dwelling ❑ Commercial/industrial 0 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.
4
JOB of new motor load of ❑ "A ", "E ", "l - 2 ", "1 - 3 ",
Job no.: Job site address: I] ]� IOOHP or more. occupancy.
I Q . / 5 - 1,0 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: !-f f_ ®, ❑ Health -care facilities. ❑ Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: P/t �( Fr ❑ Service or feeder 600 amps or more.
/ FEE SCHEDULE
Cross street/directions to job site: Description I Qty. 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
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.)
fit✓
` X- h (�(LA, Li d energy, multi-famil 75.00 2
residential above
dential (with sq. q. 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
h 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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
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 1 56.18 2
Contact name: branch circuit
Each add'l branch circuit 3 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
� 1e A \ l ' C panel, alteration, or extension. Page 2 2
Business name:
, .1 �G �t e co. Each additional inspection over allowable in any of the above
Address: g/ 0 L s C F` f�. V' El.-- V r Additional inspection (1 hr min) 66.25/ hr
,� Investigation (1 hr min) 66.25/ hr
City/State/ZIP: ea cr I \ Q`. 4 2v i Industrial plant (1 hr min) 78.18/ hr
Phone: (5 '3) c \ (3 —6 g a Fax: ( 3) �(' �O f j ' 7 Inspections for which no fee is 90.00 / hr
specifically listed ('1 hr min)
CCB Lic.: `6' • `1 i lI t Electrical Lic.: b) q Suprv. Lic.: 3 2Q ELECTRICAL PERMIT FEES
II L � I "` /
Suprv. Electrician signature, required: � • • `'� `.QS Subtotal: ' g., 41�4
Plan review (25% of permit fee): ------'
Print name: Ll 4 (y4 £S 6,5 g. Date: a '—' D---r/ State surcharge (12% of permit fee): g. y/
Authorized signature: I TOTAL PERMIT FEE: 3? - $ s
This permit application expires if a permit is not obtained within I80
Print name: 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*
❑ 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
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n 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