Permit 14 „ r`� t CITY OF TIGARD ELECTRICAL PERMIT
I" . , COMMUNITY DEVELOPMENT Permit #: ELC2011 -00478
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/25/2011
Parcel: 1S 134CB00500
Jurisdiction: Tigard
Site address: 12185 SW SUMMER ST
Project: Wilbur Subdivision: SUMMER HILLS PARK Lot: 3
Project Description: Temporary service with (7) branch circuits.
8/29/2011: REPRINTED to replace temporary sevice with regular service. DLH
Contractor: WESTERN CASCADE ELECTRIC INC Owner: WILBUR, ERIK J & JOANNA C
PO BOX 23124 12185 SW SUMMER ST
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 521 -0000 PHONE:
FAX: 503 - 620 -5430
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 08/25/2011 $100.70
Specifics: amps or less
7 crt Branch Circuits w /Purchase 08/25/2011 $51.94
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 08/25/2011 $18.32
Electrical
Type of Const:
Occupancy Grp:
Total $170.96
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' • 9: -00 5090. You may obtain a copy of the rules or direct questions to OUNC b aitin'g 2.1987 or 1.800.33 .2344.
Issued By: U h, Permittee Signature: _ ../.1 1 . . /0 4 4I III / 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
11111 > COMMUNITY DEVELOPMENT Permit #: ELC2011 -00478
Date Issued: 08/25/2011
T[GARL7 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S134CB00500
Jurisdiction: Tigard
Site address: 12185 SW SUMMER ST
Project: Wilbur Subdivision: SUMMER HILLS PARK Lot: 3
Project Description: Temporary service with (7) branch circuits.
Contractor: WESTERN CASCADE ELECTRIC INC Owner: WILBUR, ERIK J & JOANNA C
PO BOX 23124 12185 SW SUMMER ST
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 521 -0000 PHONE:
FAX: 503 - 620 -5430
FEES
Quantity Description Date Amount
1 ea Temp Services or Feeders - 08/25/2011 $59.36
Specifics: 200 amps or less
7 crt Branch Circuits w /Purchase 08/25/2011 $51.94
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 08/25/2011 $13.36
Electrical
Type of Const:
Occupancy Grp:
Total $124.66
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 955 001 -0090. You may obtain a c.-P° y of tha -s or direct questions to OUNC by cal _5A 32.1987 or 1.800.3 .2344.
Issued By: ice, /L; _ - mittee Signature:
e WNER 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 ..1V roll oFFicE USE ONLY
City Ti arC� Received lc
5 II `J b C ls Date B � Permit No.: �" �/ ----W.( :,
q 13125 SW Hall Blvd., Tigard, OR 97223 cL5
C ` Phone: 503.718.2439 Fax: 503.598.1960 0 ` U ��:� Other Permit: ��)/ -
T I GA RD Inspection Line: 503.639.4175 G�`Q, ® See Page 2 for
Internet: www.tigard- or.gov Qi �1� Supplemental Information
G
TYPE OF WORK C ��� PLAN REVIEW
ID New construction ddition/alteration/rep4de Please check all that appl ( 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
Rd...
and 2- family dwelling El
❑ Accessory building amps for all other installations. buildings.
Multi - family El Master builder ❑ Other: ❑Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ID Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: I Job site address: °2-j " Six or or more. occupancy.
U -a e s ti' JJt. M'e ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: I ` r 9'7 LZj ❑ Health -care facilities. ❑ Supply voltage for mom than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: (AA' ibb ❑ Service or feeder 600 amps or more.
t / 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.)
Limited energy, multi - family 75 00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less / 100.70 /a,O 7 -?Q 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
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 f 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 I ❑ CONTACT PERSON above service or feeder fee, 7 42 51, C( 0 2
each branch circuit
Business name: VAS Cc J H. Fee for branch circuits without
r -` ����^ service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 2
Address: Miscellaneous (service or feeder not included)
Each City /State /ZIP: dwelling, service and/or feeder 67.84 2
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: tO 7s Q(._ C panel, alteration, or.extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Po 1 r7 x 2,3 / Additional inspection (1 hr min) I 66.25/ hr
City/State/ZIP: / �� R r Q r Investigation (1 hr min) 66.25/ hr
�.4-/ Industrial plant (1 hr min) 78.18 / hr
Phone: (5Zj) ,.. t9 a O (} Fax: (52)3) 4, uj J 3 e) Inspections for which no fee is 90.00 / hr
specifically listed (%r hr min)
CCB Lie.:) S ! l I, Electrical Lie.: 3 — 4,1 i Suprv. Lie.: treg1-4.1_,SN ELECTRICAL PERMIT FEES /5. , 67 y
Subtotal: t .. y
Suprv. Electrician signature, requi�� � _ Plan review (25 %of permit fee): /PI 34
Print name a pp a.,, ( // Date - Z d,/ State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: ]
This permit application expires if a permit is not obtai within 1
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit. / 70 r 9
I: \BuitdingWermits'ELC- PcrmitApp doc 07/01/10 440- 4615T(1 I /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
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n 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
n Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n 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