Permit CITY OF TIGARD ELECTRICAL PERMIT
• ffi W COMMUNITY DEVELOPMENT Permit #: ELC2011 - 00528 • TIGARD, 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 09/27/2011
Parcel: 2S102CD02709
Jurisdiction: Tigard
Site address: 9715 SW OMARA ST
Project: Sanchez Subdivision: FREWING'S ORCHARD TRACTS Lot: PT 27 &
Project Description: (1) branch circuit for bathroom remodel
Contractor: HI DEF ELECTRIC Owner: SANCHEZ, J GUADALUPE
1110 NE 19TH CT MONNIE, DEBRA L
CANBY, OR 97013 9715 SW OMARA ST
TIGARD, OR 97223
PHONE: 503 - 891 -2231 PHONE
FAX: 503 -212 -5516
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 09/27/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 09/27/2011 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be done in - • .- -- with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days A ENTION Oreg• law •.ires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 -001 0010 through OAR 9 •-■ d 1 -00•' •u may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 - : r.0 332 2344
Issued =y: Perm ittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTA LATION ONLY
SIGNATURE OF SUPR. ELEC' 0. i l i / , Date: 9 / /��
LICENSE NO. AF/5
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Applicati . FOR OFFICE USE ONLY
City of Tigard ( Re eBy 7 // 1 Perm it No. �C[� l��5,Ag
Da
13125 SW Hall Blvd , Tigard, OR 9722P 2 7 20 11 Plan Review
R` Phone 5 2439 Fax 503,5a$,J,�60 Date/By Other Permit
T 1 G A R O Inspection Line. 503.639.4175 11 11 �1 �Y OF TI GARD Date Ready/By Ions El See Page 2 for
Internet: www.tigard- or.gov BU IL DI Notified/Method Supplemental Information
e
NG DIVISION
TYPE 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 ❑ 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
44 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 denved system A
❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
•7� / S 100HP or more occupancy
Job no.: Job site address:
9, L . l.1 0 m i s r I- Sr. ❑ Six or more residential units ❑ Recreational vehicle parks
City /State /Zip I r 1 G -- 4- 2 Z 3 ❑ Health -care 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: 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' 1 500 sq ft or portion 33 92 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
rj A h s
`ue �'e J ,� residential (with above sq ft )
r� Services or feeders installation, alteration, and /or relocation
200 amps or less 100 70 2
fj PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133 56 2
401 amps to 600 amps 200 34 2
Name: .�i c ' 1 J � � 5 ..i C 1_,_,N 601 amps to 1,000 amps 301 04 2
Address: .s n . v.L,4 rn 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
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 7 42 2
each branch circuit
Business name' B Fee for branch circuits without
service or feeder fee, first p S6 18 ��i j4 2
Contact name: branch circuit
Each add'l branch circuit 7 42 2
Address: Miscellaneous (service or feeder not included)
Ci /State /ZIP: Each manufactured or modular 67 84 2
h dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67 84 2
Pump or irrigation circle 67 84 2
E Sign or outline lighting 67 84 2
CONTRACTOR Signal circuit(s) or limited- energy '
Business name: 1.4 ; e (1 panel, alteration, or extension Page 2 2
�� Each additional inspection over allowable in any of the above
Address: \ \ \ 0 N P r 61 it, a v6 p liC< Additional inspection (1 hr min) 66 25/ hr
City/State /ZIP: 2 2 / 7 Investigation (1 hr min) 66 25/ hr
C �� q '7 Industrial plant (1 hr mm) 78 18/ hr
Phone: (co') S9 1 Z Z 3 i Fax ( S 'S 3) 2.. ( 2.- s c 1 (, inspections for which no fee is 90 00/ hr
specifically listed (%2 hr min)
CCB Lie. • 1 4-C4 Z3 Electrical Lic.: Supry Lic.:2 915 S ELECTRICAL PERMIT FEES Q
p / Subtotal 56 1 o
Suprv. Electrician signature, required: � c] C D / o
Plan review (25% of permit fee): - "
Print name , C l vs wee - �. �` w4 Date: / _ 2 4.. t!
- li State surcharge (12% of permit fee) 0
/ i
Authorized signature. 6
Z35
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: `} � �. Date: 2 )- ' I * Number of inspections allowed per permit
1 \Budding\Permrts\ELC- PermrtApp 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
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ 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
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signahng
n Other
( -
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\Buddmg\Permits\ELC- PermItApp doc 07/01/10