Permit .>t CITY OF TIGARD ELECTRICAL PERMIT
IN 3 ''_ COMMUNITY DEVELOPMENT Permit #: ELC2011 -00522
Date Issued: 09/22/2011
TE:GARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S111AA07800
Jurisdiction: Tigard
Site address: 14060 SW 89TH AVE
Project: Hendricks Subdivision• Lot:
Project Description: (1) sub -panel and (2) branch circuits for patio cover
Contractor: NORTH WOODS ELECTRIC Owner: HENDRICKS, RYAN S
9220 SW BARBUR 119 -203 POWERS, MOLLY J
PORTLAND, OR 97219 14060 SW 89TH AVE
TIGARD, OR 97224
PHONE 541 - 415 -0261 PHONE 503 231 -6368
FAX
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 09/22/2011 $100 70
Specifics: amps or less
2 crt Branch Circuits w /Purchase 09/22/2011 $14 84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 09/22/2011 $13 86
Electrical
Type of Const:
Occupancy Grp:
Total $129 40
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 ordance w - 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 ATT NTION Oregon - :• di -- you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 -001 -0 10 through OAR 952 -01 -0090 o :y obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 80 332 2344
y ' rte .✓ ;,....,, ! '�"
Issued B Permittee Signature �/.- `' �- '`^ `--------n-- //
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' °sue ' Date. .4 /®j /
c___,....-,/••--,...„...- �/ _
LICENSE NO. A66 S
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 EIVE -� : FOR OFFICE USE"ONLY ,
City of Tigard S E P 2 2011 Received e ,/,- /1 A /
Permit No ��,t a
13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
( ���
IN
Phone: 503.718 2439 Fax 503.598 1960 CITY OF TIGAR 1 Date /By Other Permit /15% th-Gl(>/.' 7
inspection Line: 503.639.4175 �pte ReadyBy. )arts WI See Page 2 for
'TI G A R D B UILDING DIVISI I I ttified/Method Su
Internet' www ttgard -or gov Supplemental Information
YPE OF WORK PLAN REVIEW
❑ New construction 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 ❑ Mannas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at I50 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
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 ", "l - ", "l - ",
Job no.: Job site address: �q(/ �'� � �.n l � r r r , p) Si xHP or more. occupancy
❑
\!Jv 1 y�}t}' ❑Six or more residential units Recreational vehicle parks
City /State /ZIP: I r r .31 c)1(2- ❑❑ Health-care oat on facilities. ❑ Supply voltage for more than
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: _ (AC C;) t „> Q,! J 4 ? . Description 1 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 5 4
Tax map/parcel no. Ea add'I 500 sq ft or portion 33 92 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq ft) 75.00 2
Limited energy, multi - family 75 00 2
i4SF .Sc) R -PA-o, c-_-_k, / P COS Le_ residential (with above sq ft )
��`` --���� ��11 Services or feeders installation, alteration, and/or relocation
6 (kW OA C1:-"C:7"- 200 amps or less ( 100 70 ) on ci Q 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
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
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
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 ❑ CONTACT PERSON above service or feeder fee 2, 7 42 ` /�i Vi 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'I 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
CONT CTOR Signal circuit(s) or limited- energy
Business name: I l h2�� 6 6 S panel, alteration, or extension Page 2 2
tutu VVV"`-��� Each additional inspection over allowable in any of the above
Address: �j°Z� k.) (� x`� n i l 1 G - 203 Additional inspection (I hr mm) 6625/hr
i ^ Investigation (1 hr min) 66 25/ hr
City /State /ZIP: PIP
V Industrial plant (1 hr min) 78 18/ hr
Phone: (( ) 1 -4 . 1g - 02-6. 1 Fax: ( ) 1 Inspections for which no fee is 90.00 / hr
specifically listed (% hr mm)
CCB Lic.: 4 1 3 Zl h Ele trical Lic.: C 0 Suprv. Lic.: (4 - Zo6 S ELECTRICAL PERMIT FEES
421/A 101 Subtotal i
Suprv. Electrician signature, re ired: Plan review (25% of permit fee).
Print name. Yo e ., v. - + Date: c `Z� State surcharge (12% of permit fee). ( r g
1 / TOTAL PERMIT FEE. / g, V
Authorized signature:
_ This permit application expires if a permit is not obtained within 180
�/
..../ days days after it has been accepted as complete.
Print name: _A a Date: • o 7 2 , Z * Number of inspections allowed per permit
I \Bwldmg\Permits\ELC- PermitApp doe 07/01/10 440 44615T(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
❑ Garage Door Opener*
❑ 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:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n 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
I \Buildmg\Permits\E.LC- PermitApp doe 07/01/10