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Permit CITY OF TIGARD ELECTRICAL PERMIT 1 ,114 2 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00513 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 09/16/2011 Parcel: 2S104DD06300 Jurisdiction: Tigard Site address: 12636 SW GAARDE ST Project: SMART Subdivision: EAGLE POINTE Lot: 59 Project Description: (2) hours of additional inspection time for expired permits: ELC2005 -00367 and ELC2004- 00216. Contractor: OWNER Owner: SMART, DAVID E & JERI L 12636 SW GAARDE ST TIGARD, OR 97223 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 2 hr Hourly Electrical Rate 09/16/2011 $180 00 Specifics: 1 ea Hourly Electrical 12% 09/16/2011 $21.60 Surcharge Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $201.60 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 952 - 001 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503 23 1987 0 1 800 3 4 Issued By: J' ...0Ll Permittee Signature: AISINW 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 City of Tigard ��1� Date/B h - P ■If>♦ Permit No 5- L f! ,_ . - - q 13125 SW Hall Blvd., Tigard, OR, 9'0 t Yv Plan Review ill Phone' 503.718.2439 Fax 503 59: ''- 011 Date/BY Other Permit. T I GA RD Inspection Line: 503 639 4175 D 16 Date Ready /By Juris ® See Page 2 for Internet www tigard - gov S` ` P I AD Notified/Method '-7--rii Supplemental Information T E OF WO 0 �� y l � l - PLAN REVIEW v ent Please check all that apply (submit 2 sets of plans w /items checked below). ❑ New construction © Addition/alter i. B P. . ❑ 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 0"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.: Job site address: /)._.( ( a S j � 1 Six or or more residential Recreational V t l'i/.t � ❑ Six or more residenhal units El R vehicle parks City /State /ZIP: 7 i U A `, 01.(c- ❑ Health -care facilities 0 Supply voltage for more than ❑Hazardous locations. 600 volts nominal Suite /bldg. /apt. no.: l.1 Project name: ; 1 , -}— ❑ Service or feeder 600 amps or more FEE SCHEDULE Cross street/directions to job site: Description 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 residential (with above sq ft ) Services or feeders installation, alteration, and/or relocation 200 amps or less 100 70 2 ROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133 56 2 ` 401 amps to 600 amps 200 34 2 Name: ; C'- >/19G (j/ Q, 601 amps to 1,000 amps 301 04 2 Address: + Z ‘36 �/(� e � . e Over 1,000 amps or volts 552 26 2 Cit y A 9'7Z-z3 Temporary services or feeders installation, alteration, and /or /State /ZIP: / � relocation Phone: ( ) S7 " - S'J 7 Fax ( ) 200 amps or less 59 36 1 201 amps to 400 amps 125 08 2 Owner installation: T is installation is being made on property that I own which is not intended for sale, leased ent, orf •. ;n. - aces e' g to ORS 447, 449, 670, a d 701. 401 amps to 599 amps 168 54 2 i 9�i Branch circuits — new, alteration, or extension, per panel Owner signature: 1 Date: A. Fee for branch circuits with CI APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit Business name. . C /( - B Fee for branch circuits without service or feeder fee, first 56 18 2 Contact name: branch circuit Each add'I branch circuit 7 42 2 Address: Miscellaneous (service or feeder not included) Each manufactured or modular 67 84 1 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: panel, alteration, or extension Page 2 2 �'J�� Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66 25/ hr Investigation (I hr min) 66 25/ hr City /State /ZIP: Industrial plant (1 hr mm) 78 18/ hr Phone: ( ) Fax: ( ) Inspections for which no fee is specifically listed (% hr min) 90 00/ hr '` __ CCB Lic.: Electrical Lic.: Suprv. Lie.: ELECTRICAL PERMIT FEES Subtotal: (S -- Suprv. Electrician signature, required: Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee). 4 /, TOTAL PERMIT FEE. 1 (, i;„Z— Authorized signature: This permit application expires if a permit is not obtained within 180 Print name: Date: # days after it has been accepted as complete. Number of inspections allowed per permit I \Buddmg\Permits\E1.C- PermiApp doe 07/01/10 440- 4615T(11 /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* n 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 ❑ Boiler Controls ❑ Clock Systems n Data Telecommunication Installation n Fire Alarm Installation ❑ HVAC ❑ Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* n 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 1 \Buddmg\Permits\ELC- PermitApp doc 07/01/10 Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the 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 per mits. 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 licensed with the Construction Contractors Board. or 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 horn eowner statement is true and accurate. \ \ e,---■/ 1 dt 5-- /Y, 1 6 , A Print N 0 e Permit Applicant E Z --- 1 `) 1- , 9 /0 - I/ Signature of Permit Applicant Date Permit #: -Le---)611— ,->.-hs1 1 Address: I�(r; 3(g 5t-ti 6- 4 ,., a t; • :: : r ;tu.-avE i . �) ‘ l OR_ 6:1-7)")--? :•O � . & Issued by: f3 - I • Date: c t/ � /11 fit This Copy for Permit Offices