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CITY OF TIGARD ELECTRICAL PERMIT
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1111 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00403
Date Issued: 07/19/2011
. TI CARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Parcel: 2S111 BB01501
Jurisdiction: Tigard
Site address: 14135 SW 103RD AVE
Project: LEMLEY Subdivision: Lot:
Project Description: Adding (1) service and (1) branch circuit to detached garage. 9/14/11, reprinted permit to include (4) branch
circuits.
Contractor: OWNER Owner: LEMLEY, DANIEL M
14135 SW 103RD AVE
PORTLAND, OR 97224
PHONE: PHONE:
FAX
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/19/2011 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 07/19/2011 $7 42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 07/19/2011 $12.97
Electrical
Type of Const: 30 Electrical Permit 09/14/2011 $29 68
Occupancy Grp: 4 12% State Surcharge - 09/14/2011 $3.56
Electrical
Total $154 33
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 ,AAR
952- 001 -0010 through 0A"52-001-0090 You may obtain a copy of th ules or • -ct questions to OUNC by calling 503.232 1987 or 1 800 3 2344
Issued By: .P_j�. - — - 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.
CITY OF TIGARD ELECTRICAL PERMIT
`' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00403
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/19/2011
Parcel: 251118801501
Jurisdiction: Tigard
Site address: 14135 SW 103RD AVE
Project: LEMLEY Subdivision: Lot:
Project Description: Adding (1) service and (1) branch circuit to detached garage.
Contractor: OWNER Owner: LEMLEY, DANIEL M
14135 SW 103RD AVE
PORTLAND, OR 97224
PHONE
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/19/2011 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 07/19/2011 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 07/19/2011 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $1.21.09
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 OAR '52- 001 -0090. You ma o• a cops or direct questions to OUNC by calling 503.232.1987 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 Application FOR OFFICE USE ONLY
Received * City of Tigard 0 \\ Date/3y: j-
7 . / �" /1 No.: EEC�vl/''CY . 1'o
13125 SW Hall Blvd., Tigard,OR °t7 z Plan Rev f%"
Phone: 503.718.2439 Fax: 503.59.e ��� � � \ 0 :� ® f �, xDateB Other Permit:
TI G A R D Inspection Line: 503.639 4x\ , b Ready /By: luris: See Page 2 for
Internet: www.tigard- or.gov N A �`�� 1 \C J Notified/Method. 1137-4 ® Sup Information
TYPE OF WORK 6 i � ' l PLAN REVIEW
Addition /alteration /re 3)i Please check all that apply (submit 2 sets of plans w /items checked below):
El New construction � ement
■ ❑ 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
W 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.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: 1 Job site address: / H I% SLJ t 03 to ,[� v6 I00HP or more. occupancy.
❑
' ❑Six or more residential units. Recreational vehicle parks.
City/State /ZIP: -r( G Nz„b , 0 Y> `) Z 2_L-I ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Six.) h c D sp✓ (...p ¶l,A-) Io Description I otv. I Fee. I Total T
New residential single- or multi - family dwelling unit.
// Includes attached garage.
Subdivision: //Q Lot no.: 1,000 sq. ft. or less 168.54 4
l 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
L b °Z,4, ck (v la -'Pt 1) j i w t Awe- residential (with above sq. ft.)
! _ "`mot Services or feeders installation, alteration, and/or relocation
/
200 amps or less 100.70 1 O ,7e; 2
• ag. PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:'��)1 — 4' "1 L p/1 L y U 601 amps to 1,000 amps 301.04 2
Address: p...// 5 5 �J /03 Q� AV ( Over 1,000 amps or volts 552.26 2
/State /ZIP: / 0 Temporary services or feeders installation, alteration, and /or
City/State/ZIP: �(? C� A Lam 0 97 Z241 relocation
Phone: (c ) si, i.,/ (d1 % 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, arld 7 .
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: ? / e f Z '" 0 A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT .PERSON above service or feeder fee, 1 7.42 7 Ell 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 - mail:
Sign or outline lighting 67.84 2
CON RACTOR Signal circuit(s) or limited- energy
Business name: ®w 1,, j � � Occu PI e5 panel, alteration, or extension. Page 2 2
/// Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed.( %z hr min) 90.00 / hr
CCB Lie.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT' FEES
Suprv. Electrician signature, required: ° Subtotal: �' 0 $.1;�
Plan review (25 /° of permit fee): —
Print name: Date: State surcharge (12% of permit fee): )-. 4 7
TOTAL PERMIT FEE: t ,7 , t3
Authorized signature :
This permit application expires if a permit is not o tained within 180
days after it has been accepted as complete.
Print name: 1 /1 / / L L , 6 Date: "7 / /2,0 i i + Number of inspections allowed per permit.
\ P \
I:\ Building ermitsELC- PermittA 07/01/10 440- 4615T(11/05 /COM/WEB
Electrical Permit Application � �' FOR OFFICE USE ONLY
City of Tigard ��f� A t� . ateiv d /L MM ow eL C ( -coif S
° 13125 SW Hall Blvd., Tigard, OR 97223 ,, l___ 1 13 � ��
, . II ' '' Phone• 503 718 2439 Fax • 503 598 1960 S�Q y 1 g e ` Other Permit:
Tt GA RD Inspection Line 503.639.4175 �rS1' `�'+ /By Juns 0 see Page 2 for
Internet. www.tigard - or.gov c1 o 1'b ified/Method /j J( Supplemental Information
TYPE OF WORK (5� � PLAN REVIEW
❑ New construction ❑ Addition /alteration/replacement Please check all that apply (submit 2 sets of plans whtems checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: where the available fault current ❑ Mannas 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 denved system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: / "(o S /9.3.-- 100IP or more occupancy
-. ❑ o
Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: ❑ I Iealth - care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite /bldg. /apt. no.: Project name: ❑ 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'l 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 )
J f Limited energy, multi - family 75 00 2
4 PC 1 �k- L t•( b r - < A.-- ,, rim - hp pc-V/,‘6- 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 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, i er 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
W service or feeder fee, first
Contact name:
branch circuit 56 18 2
Each add'I branch circuit 9 7 42/ , 4 2
Address: Miscellaneous (service or feeder not included) l
Each manufactured or modular
City/State /ZIP: 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 name: panel, alteration, or extension Pa•e2 2
OLAJ - C r Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66 25/ hr
investigation (1 hr min) 66 25/ hr
City /State /ZIP: Industnal plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed (/s hr min) 90 00/ hr
CCB Lie.: Electrical Lie.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Subtotal a-01, c
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (12% of permit fee) 3 .
TOTAL PERMIT FEE 33. A`(
Authorized signature:
This permit application expires if a permit is not obtained within l 0
� 4 , 6 � ,/� , �- /, / ; e /
days after has been accepted as complete.
`g
Print name: r t (ma t/J Date: �( / Number of inspections a llowed per permit
I \Buildmg\Permits\ELC- PermitApp doc 07/01/10 (/ 440- 4615T(I 1 /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
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
1 \Buildmg\Permits\ELC- PermitApp doc 07/01/10
Property Owner Statement
Regarding Construction Responsibilities
Law requires residential construction permit applicants on La e s p pp licants who are not licensed with the
9 q
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that a II subcontractors who work on the structure must be
license with the Construction Contractors Board.
I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this hom eowner statement is true and accurate.
(://�►�' � fit �-G M [�
Print Name of Permit Applicant /
'7 /Vte
Signature of Permit Applicant Date
Permit #: -/1/1 CO `70 ,7 �
J,
Address: / Ski /0 n s;;
Issued by: e.7 Date: *J
This Copy for Permit Offices