Permit CITY OF TIGARD ELECTRICAL PERMIT
• -'- COMMUNITY DEVELOPMENT Permit #: ELC2011 -00457
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/11/2011
Parcel: 2S102AB02402
Jurisdiction: Tigard
Site address: 12501 SW MAIN ST
Project: Allstate Insurance Subdivision:ELECTRIC ADDITION TO TIGARDVILLE Lot: 15
Project Description: Electrical for TI.
Contractor: TRINITY ELECTRIC Owner: ANKELE, MARVIN R & KATHRYN J
13422 SW 128TH PL 12511 SW MAIN
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 235 -6481 PHONE:
FAX: 503 - 579 -3929
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 08/11/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/11/2011 $7.63
Type of Use: COM Electrical
Class of Work: ALT 64 Investigation Fee (Equals 08/11/2011 $63.60
Permit Fee)
Type of Const: 1 ea Investigation 12% Surcharge 08/11/2011 $7.63
Occupancy Grp:
Total $142.46
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 O:; •52- 001 -0090. You may obtain h= u es o •' -ct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Or
Issued By: _ Permittee Signature:
JO 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 tV . FOR OFFICE USE ONLY
City of Tigard DateB •
Permit No.: ,
III �l (� ��I 7
q 13125 SW Hall Blvd., Tig. �; 3 �0�� Plan Review
Phone: 503.718.2439 Fax:'. •' . ' 98.196Q N. Date /By: Other Permit:
Ti G A R D Inspection Line: 503.639.41 5 \ V ` Date Ready/By: Jam 7 H See Page 2 for
Internet: www.tigard or.gov p, � Cj IlCD\ Notified/Method: - 4.-- 6/ Supplemental Information
OF� i4s PLAN REVIEW 00
❑ New construction 'Addition /altgre replacement
Please check all that apply (submit 2 sets of plans w /items checked below):
v • ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: 1) 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.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 - ",
IOOHP or more. occupancy.
Job no.: Job site address:
S0/ S it/ 14A )n Sfree- - ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: T / OR 9v- � ❑ Hazardous l o itions. 600 ❑ Supply volts voltage for more than
l 1 /.l')"'cj / �, / ❑Hazardous oaons. volts nominal.
Suite /bldg. /apt. no.: Project name: 4/ /9 T / . 1 - n eiyQ�� El Service or feeder 600 amps or more.
7 FEE SCHEDULE
Cross street/directions to job site: Description p 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
piu6 au L / ,�, / F7( 1LC ,., - 5W � < residential (with above sq. ft.)
t V � 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
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: 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, fast / 56.18 is, 2
Con tact name: branch circuit
Each add'I branch circuit I 7.42 9, C43- 2
Address: Miscellaneous (service or feeder net 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
CONTRACTOR Signal circuit(s) or limited- energy
Business name: 7r - (r11, / / r panel, alteration, or extension. Page 2 2
� Y C Each additional inspection over allowable in any of the above
Address: / a..)._.Z 5-m/ / � . A5, L-A Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr.min) 66.25/ hr
City/State /ZIP: /- .� Q . r � /' V 7 � _?__2� industrial.plant (I hr min) 78.18 / hr
(/
Phone: g ( [� Q Fax: 2 � - Inspections for which no fee is
�� — T - / �J����- 7 specifically listed (%z hr min) 90.00 / hr
CCB Lie.:- Electrical Lic.: 4 Suprv. Lie.: ELECTRICAL PERMIT FEES
Suprv. Electrici. / required: t6 6 ')( 4
Plan review (25 %of permit fee): Subtotal:
p fl a r e , re wired: 1 (� , 11 l3 �'
J
Print name: Date: 8 , ii . State surcharge (12% of permit fee): '7 , L 3 X r_
.
• TOTAL PERMIT FEE: / Lja Ii Ce
Authorized signature: �-
i This permit application expires if a permit is not o @tamed within 180
✓ Date: I � *
days after has been accepted as complete.
Print name:
Tel S, � yj � f t* Number of inspections a llowed per permit.
I:\Building \Permits\ELC- PermitApp.doc 07/01/10 4404615T(11/05 /COM/WEB
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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*
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
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ 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