Permit r
� r CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 00360
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/21/2009
Parcel: 2S 103 BD01800
Jurisdiction: Tigard
Site address: 11905 SW CARMEN ST
Subdivision: Lot: 0
Project: WIENCEK
Project Description: Add /alter (3) branch circuits for bathroom remodel.
Owner: FEES
WIENCEK, DAVID M & DIANNE M Quantity Description Date Amount
11905 SW CARMEN ST 3 crt Branch Circuits 07/21/2009 $60.15
TIGARD, OR 97223 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/21/2009 $7.22
Electrical
Contractor: .
FRAHLER ELECTRIC CO
11860 SW GREENBURG RD
TIGARD, OR 97223
PHONE: 503 - 639 -4627
FAX: 503- 639 -4673
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $67.37
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 9952- 001 -0100. You may obtain a copy of the
e� rules or direct questions to OUNC by calling 503.246.6699
� 03.2466 or 1.800.332.2344.
Issued By: ..� - 1_! _ t .JA7t Permittee Signature: ,-.... 0 `*81
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 an inspection that business day.
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.
v
`° ECEIVED - —
Electrical Permit Applicatio FOR OFFICE USE ONLY
'
City of Tigard 2009 Received
. II :.. 2 2009 __rill_ No: d • , %, • 0
a 13125 SW Hall Blvd., Tigard, OR 97223 2 Date/By: Permit No •
Phone: 503.639.4171 Fax: 503.598:1960
Date/By Other Permit:
Inspection Line: 503.639.4175 Date Ready/13y: MI 0 See Page 2 for
TIGARD Internet: www.tigard or.gov CITY OF TIGARD Notified/Method: f (r-, Supplemental Information
BUlLJING DLVISiON i •
TYPE OF WORK PLAN REVIEW
❑ New construction )1 Addition/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
• El 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings
❑ Multi -family El Master builder El 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.: 66793 Job site address: 11905 SW CARMEN STREET 100HP or more occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: TIGARD, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: WIENCEK RESIDENCE ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Desorption I Qty. I Fee. I Total I
New r esiilential single- or muiii- famiiy dwelling unit.
Includes attached garage. .
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
•
WIRING IN REMODELED BATHROOM residential (with above sq. ft )
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps , 106.85 .. 2
- .Name: - • - - 401 amps to 600 amps . _ 160:60 _ ... 2
601 amps to 1,000 amps _ _ 240.60 2
. - Over 1,000 anips•or volts -° 454.65 . . . 2_ .
City /State/ZIP: - - - - Temporary services or feeders installation, alteration, and /or
relocation '
Phone: ( • ) Fax: ( ) - - 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 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,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
without service or feeder fee, 1 46.85 46.85 2
Contact name: first branch circuit
Address: Each add'l branch circuit • 2 I 6.65 1 13.30 2
Miscellaneous (service or feeder not included)
City / State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: FRAHILER ELECTRIC COMPANY . energy panel, alteration, or
Address: 11860 SW GREENBURG ROAD - extension. Describe: . Page 2 2 • City / State/ZIP: TIGARD, OR -- 97223 Each additional inspection over allowable in any of the above
Perinspection � . -- ._ _ _ _ 62.50' _L _ . -,..
- Phone: ( 503 639� 4627 Fax ( 503) 639 =4673
In4estigation per'hour (1 hr in)_ _ ___ _ .. 62.50 . .. _.
CCB Lic:: 37410 - - Electrical Lic.: 34=13C Suprv. Lic:: - .18165 .- - Industrial plant per hour_ _ . _.__... 73.75 .
11' +( 1 b ,' i f U ' ELECTRICAL PERMIT FEES _.
Suprv. Electrician n s i gnature, re d: �/ AA/11 Subtotal: 60.15
Print name: R W. FRAHLER Date: 07/16/09 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 7.22
Authorized signature: • TOTAL PERMIT FEE: 67.37
Print name: Date: This p ermit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
•
RESIDENTIAL WORK ONLY:
Fee-for-alt residential systems combined $75.00 . , -
.
Check.T -of Work Involved: : _....
❑ Audio and Stereo Systems* •
n 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'
n Clock Systems
•
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n
InstLVmentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape - Lighting*
❑ Protective Signaling • _
n Other • .
•
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
•