Permit , CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00468
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/19/2011
Parcel: 2S101AD00400
Jurisdiction: Tigard
Site address: 6655 SW HAMPTON ST 110
Project: Noreen Spiegel, CPA Subdivision: WEST PORTLAND HEIGHTS Lot: 14 -31, P
Project Description: (1) branch circuit for wall outlet.
Contractor: FUZION ELECTRIC LLC Owner: HAMPTON OAKS LLC
21782 SW KRISTIN CT 6665 SW HAMPTON
ALOHA, OR 97006 2ND FLOOR
TIGARD, OR 97223
PHONE: 503 - 528 -6033 PHONE:
FAX: 866- 284 -0482
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 08/19/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/19/2011 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports (Conditions)
This • • mit is issue. • • to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other - •plicable law. All work will
be ••ne in accordance with - pproved plans. This permit will expire if work is not started within 180 days of issuance, or if w is spended for more the 180
day.. ATTENTION: Oregon law re•.. a you to follow the rules adopted by the Oregon Utility Notifi- -'• - enter. T se es are set forth in OAR
952 001 -0010 through OAR 952 -00 •090. ou may obtain a copy of the rules or direct questions to OUNC by calling ' • .1987 or 1. 0 33' 444.
Iss •d By: f� Permittee Signature: 1
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:
I • • TRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' ( lc Date:
LICENSE NO. l
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 o FOR OFFICE USE ONLY
City of Tigard Da R e a 0 ��� Permit No.: f LCA0 /I d Q d
II ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review /�
` C . Phone: 503.639.4171 Fax: 503.598.1960 Date/B ttil
: Other Permit: j � of - DO/-75
I l C. A It D Inspection Line: 503.639.4175 Date Ready /By: bids: El See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK. PLAN REVIEW
❑ New construction , ddition /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 ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ommercial /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 ", "I -2 ", "t -3 ",
Job no.: Job site address: ��/� �j � �) i ` 100HP or more. occupancy.
lL1lY` �� N ( P V r l Jrt Ira ❑S or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: �r o� c ❑ Health -care facilities. ❑ Supply voltage for more than
t 1 ❑ 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 ( 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 I
Tax map /parcel no.: Limited energy, residential
. DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
7 l., )L #-�� 4 / -
Limited energy, multi-family 75.00 2
v�v^'Cn� C e �- residential above
dential (with sq. q. ft.)
Services or feeders installation, alteration, and /or relocation
fl ) 1. ."Yek.. ( // ( 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 I
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
0 APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: EJ' C3N C i G j.�� B. Fee for branch circuits without
.r �t (( service or feeder fee, first 56.18 2
Contact name: Y, • As branch circuit
n V� � r , \ t Each add'I branch circuit 7.42 2
L
Address: Il f 0 2 c�(.�� � lr h5 (v\ Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State /ZIP: ( i a `2 60 dwelling, service and/or feeder
Reconnect only 67.84 2
Phone: ( 3 sz / � 1 ' 6 Fax: : ( )
)o►-� {- 0 2.tc'4 .-1 .ec' r C...���✓\ Pump or irrigation circle 67.84 2
E -mail: I t;,.
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: f Cite) Gcl'G 1......0 G panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (I 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 •
F.9.-71y specifically listed (% hr min) 90.001 hr
CCB Lic.: / O q ! I Q Electrical Lic.: CDC) Suprv. Lic.: ✓ �5 ELECTRICAL PERMIT FEES ,
r Subtotal: 5," / :1
Suprv. Electrician signature, required:
_ / -' it "" ] Plan review (25% of permit fee):
Print name:Zrr. 1 �'I/t -, Date: 1/ 1 1 / State surcharge (12% of permit fee): / / Z TOTAL PERMIT FEE: �a. j ? /
2 �
Authorized signature: " y'. . l' ,1 II Thi permit application expires a lication ex ires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name:
_ - I Date: 1 0- 4
8 ` o 1 + • Number of inspections allowed per permit.
1:\Building\Permits\ELC- PermitApp.doc 07/01/10 4 615T(I l /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:
n Audio and Stereo Systems*
n 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:
n Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n 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