Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00492
• TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/07/2011
Parcel: 1 S134CD00800
Jurisdiction: Tigard
Site address: 11795 SW KATHERINE ST
Project: Henderson Subdivision: LERON HEIGHTS NO.3 Lot: 78
Project Description: Panel replacement.
Contractor: ELECTRICAL INNOVATIONS Owner: HUDSON PLAZA LLC
22300 S LEWELLEN RD 11795 SW KATHERINE ST
BEAVERCREEK, OR 97004 - 8733 TIGARD, OR 97223
PHONE: 503 - 358 -6989 PHONE:
FAX: 503 - 632 -6564
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 09/07/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 09/07/2011 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 OA: • . J01 -0090. You may obtain a copy of the rules or rules questions to OUNC by calling 503.23 1987 or 1.800.332. 344. \r
Issued By = —t o— / 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 OFFI(.E•USE ONLY
R
City of Tigard e Date B : � I P N o.: a 7 l — p (.... '�
O 13125 SW Hall Blvd., ig: D 972 3,, q qq Plan Rev iew
' 2 ' Phone: 503.718.2439 t n 03598.1960 � \\ Date B : Other Permit: 'I'1GAR1) Inspection Line: 503.63'' 1.6'1 Date Ready/By: 0 See Page 2 for
Internet www.tigard ��Q P t^t Notified/Methad: Supplemental Information
TYPE OF WOl2 '\ \' ' ' ^fil PLAN REVIEW
s . �. t1�',�t�
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction AdditiortIt ati� c nJ e lacement ❑ Building aver three stories.
^���e; ❑ Service or feeder 400 amps or snore g
❑ Demolition El Other: 0 \ \\ „ta µ 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
A l- and 2- family dwelling ❑ Conunercialfmdustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 75 KV A or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system, larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ,
Job no.: i Job site address / 7,5"...56j 1001-1P or more. occupancy.
SS.� ' 0 Six or more residential units. ❑ Recreational vehicle parks.
City /State/ 2J �j� ` .i..� ew; ❑ Health -care facilities. ❑ Supply voltage for more than
' j �� / 5 y�1`^/�� I r t' ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: /--p t p ( ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 111 ^^^ ��� fill!! J'�
� Description i Qty. I Fee. I Total
New residential single- or multi - family dwelling writ
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
ea ii, e - ( G t s.e residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100.70 i db,)0 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
j / / 401 amps to 600 amps 200.34 2
Name: JC� r Js ,/
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 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, r panel
Owner signature: Date: A Fee for branch circuits with
❑ APPLICANT I ❑ 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, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: • Miscellaneous (service. or feeder not included)
City/State/ZIP: Each manufactured or modular 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
` panel, alteration, or extension. Page 2 2
Business name
tl L° 'rt ca t Sv1p1 011c, � t CpeL _Ty c Each additional inspection over allowable in any of the above
Address: • z,2 3o0 S L e..t,u . / e- e / Additional inspection (1 hr min) 66.251 hr
City /State/ZI e_U ✓, fc l �` 0 / 9 700 y Investigation (1 hr min) 66.25/ hr
s / Industrial plant (1 hr min) 78.18/ hr
Phone: (.5-03) 35 6 9..57 Fax: CS-03 " — �S 1' Inspections for which no fee is 90.00 / hr
specifically listed Ch hr min)
//
CCB Lic.: all/ lr`/ 7 tt Electrical Lic. d —(j ` 5. Suprv. Lic.36� 3 ELECTRICAL PERMIT FEES
Suprv. Electriciad4atlfe, required:U -�� fU I / Subtotal: (UD '70
/"--.-- Plan review (25% of permit fee): _�
Print name Th 7vV �T -1/tu Date: Statesurcharge(12 %ofpermitfee): (a ,CS $`
TOTAL PERMIT FEE: ( 1 ),,,; g
Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date:
Number of inspections allowed per permit.
t:lBuitding\PemutstELC- PemutApp doe rr1101/10 440- 4615T(1 I /05/COM/WED
•