Permit d ,! CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00393
'TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/15/2011
Parcel: 25111 CC07100
Jurisdiction: Tigard
Site address: 15885 SW GREENS WAY
Project: Hickert Subdivision: Lot:
Project Description: (1) 200 amp service and (2) branch circuits
Contractor: FRAHLER ELECTRIC CO Owner: HICKERT
11860 SW GREENBURG RD 15885 SW GREENS WAY
TIGARD, OR 97223 TIGARD, OR 97224
PHONE: 503 - 639 -4627 PHONE:
FAX: 503 - 639 -4673
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/15/2011 $100.70
Specifics: amps or less
2 crt Branch Circuits w /Purchase 07/15/2011 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 07/15/2011 $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 0 R 952- 1 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: i ,9' L ie'97
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.
l
Electrical Permit Application FOR OFFICE USE ONLY
Received
_ C ity of Tigard �j Date /Bv: �5 (/ 2/4' - Permit Noe7C 7/ — oOg
a 13125 SW Hall Blvd., Tigard, OR .64 1` O\\ Plan Review
' ' = Phon • 503.718.2439 Fax: 503.5 !' .0 Date /Bv: Other Permit: •
TIGARD Inspection Line: 503.639.4175 ` Date Ready /B y: See Page 2 for
Interne[ www.tigard J � 115 S Notified /Method: Supplemental Information
1 YPE OF WOR CSC ; PLAN REVIEW° -
� Please check all that apply (submit 2 sets of plans w /dews checked below):
❑ New construction ® Addition /alteratiol ement
El Demolition ❑ Other:
❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
-. "' .(' - ..r" -' " CA J " ' " . , Floating buildings.
r -EGORY OF CONSTRUE,. ,4 - - _ exceed 10,000 amps at 150 volts or ❑
` less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® I- and 2- family dwelling El Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
y z ❑ Emergency system. larger separately derived system.
-- 7 SI1i IN RMAT
FOIO AND LOCATION T . , 41 � - ❑ Addition of new motor load of ❑ "A ", "E ", ' l -2 ", 'l 3 ",
Job no.: 68622 Job site address: 15885 SW GREENS WAY 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: TIGARD, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: HICKERT RESIDENCE ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: EH F �CEIED IOE Fee. t 'fl.
Cross
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
, ° - • DESCRIP,TION OF WORK A -.r„ . (with above sq. 0.)
Limited energy, multi - family
REPLACE ELECTRICAL PANEL /REPLACE ALL OUTLETS AND SWITCHES residential (with above sq. ft.) 75.00 2
AND PIGTAIL AL WIRING Services or feeders installation, alteration, and /or relocation
200 amps or less 1 100.70 100.70 2
t _ _ 201 amps to 400 amps 133.56 2
PROPERTYOWNER ® TENAN
v _
�_. T 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
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
200 amps or less 59.36 1
Phone: ( ) Fax: ( ) 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
above service or feeder fee, 2 14.84
i, . ❑ APPLICANT - r ; - 3 .. �❑ NT
COA CT PRSO
EN each branch circuit 7A2 2
Business name: B Fee for branch circuits n-ithoma
service or feeder fee, first 56.18 2
branch circuit
Contact name: Each add'I branch circuit I I 7.42 12
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
67.84 2
City /State /ZIP: dwelling, service and/or feeder
Reconnect only 67.84 2
Phone: ( ) Fax: : ( ) Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
.1:11.',415,.. ' ' y'., w, ..CONTRACTOR - :., w x Signal circuit(s) or limited- energy
' panel, alteration, or extension. Page 2 2
Business name: FRAHLER ELECTRIC COMPANY Each additional inspection over allowable in any of the above
Address: 11860 SW GREENBURG ROAD Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City /State /ZIP: TIGARD, OR 97223 Industrial plant (I hr min) 78.18/ hr
Phone: (503) 639 - 4627 Fax: (503) 4673 Inspections for which no fee is 90.00 / hr
specifically listed (1/4 hr mm)
'
�CB Lic.: 37410 ,,Ie, Electrical Lic.: 34 -13C /Pi/ // Suprv. Lic.: S110S l 2 J 2- - , -, . . ;CLECTR1CAL 2PFRMTT-
: Fh ES :k, -. . r '
'� �� (01 l I Subtotal: 115.54
`� (
Suprv. Electrician signature, required: i!� Plan review (25% of permit fee):
Print name: ADAM ETHERINGTON ��% ° °° Date: 07/13/11 State surcharge (12% of permit fee): 13.86
TOTAL PERMIT FEE: 129.40
Authorized signature: This permit application expires if a permit is not obtained within 180
(lays after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
I: \Building \Permits \ELC- PermitApp.doc 07/0 I /10 440 4615T(t l /05 /COM/WEB