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Permit 1 0 /(9 / fie_rty\il\-- - to k'N cAcAr) (1—; c.)./vc.( . 8 7\ CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00551 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/05/2011 TIGARD g Parcel: 2S102DD01400 Jurisdiction: Tigard Site address: 8710 SW OMARA ST Project: HOLSTEIN Subdivision: EDGEWOOD Lot: 8 Project Description: Service upgrade. 10/06/11, reprinted permit to include (1) additional service Contractor: SCOTT -CO ELECTRIC INC Owner: HOLSTEIN, MARVIN R /LORETTA R TRS P O BOX 92 8710 SW OMARA BORING, OR 97009 TIGARD, OR 97223 PHONE' 503 - 668 -7111 PHONE FAX 503 - 668 -3104 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 10/05/2011 $100 70 Specifics: amps or less 1 ea 12% State Surcharge - 10/05/2011 $12 08 Type of Use: SF Electrical Class of Work: ALT 1 ea Services or Feeders - 200 10/06/2011 $100.70 amps or less Type of Const: 12 12% State Surcharge - 10/06/2011 $12 08 Occupancy Grp: Electrical Total $225 56 Required Items and Reports (Conditions) i This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Speci. Code and - of applic- • e law All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of issue e, • if w• - i - - •ende for more the 180 days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility N•.ification - - t= .- - rules a set forth in OAR 952- 001 -0010 through 0 001 -0090 You may obtain - • • . •. • e rules o •u` questions to OUNC by callin 503.232.19: or /ill a 32. • 4 Issued By: _ �•rmittee ii ature: 4 � „ •WNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent f 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. q CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00551 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Date Issued: 10/05/2011 Parcel: 2S102DD01400 Jurisdiction: Tigard Site address: 8710 SW OMARA ST Project: HOLSTEIN Subdivision: EDGEWOOD Lot: 8 Project Description: Service upgrade. Contractor: SCOTT -CO ELECTRIC INC Owner: HOLSTEIN, MARVIN R/LORETTA R TRS P.O. BOX 92 8710 SW OMARA BORING, OR 97009 TIGARD, OR 97223 PHONE. 503 - 668 -7111 PHONE FAX 503 - 668 -3104 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 10/05/2011 $100 70 Specifics: amps or less 1 ea 12% State Surcharge - 10/05/2011 $12 08 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 . = • uired Items : nd R= sorts (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty ' ode- and all other applicable aw All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of su- e, o spender• for , • the 180 days. ATTENTION Oregon law requires you to follow the rules ado•tedd by the Oregon Utility Notifi•- tio/�Cente Those r • -s ar= se •h in O•' 952- 001 -0010 through OAR 95 - 001 -0090 You may obtain ay• n. •� a ru = ::::::: X32 1987 or 1 800 3 4. Issued B ' : . . -W GAO OWNER INSTALLATION ONLY Fir 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 r'% \\ d ec eiv ed / 11 q 131 SW Hall Blvd., Tigard, t ® � :Yan Review PenmtNo f/ rU Phone: 503 718 2439 Fax. 5 . 8,1:960 % ,_ ! Date /By Other Permit T 1 G'ARD Inspection Line • 503 639.4175 �\ .t ®`� <� Date Ready/By Juris ® See Page 2 for Internet www tigard -or gov Q a \;. Notified/Method C9 Supplemental information ' i" PLAN REVIEW TYPE OF WORK' r �` ❑ New construction dd ition /alteration/r� place 1 \ \t` ment Please check all that apply (submit 2 sets of plans w /items checked below) 1\ ❑ Service or feeder 400 amps or more ❑ Building over three stories ❑ Demolition ❑ Other: c\r' where the available fault current ❑ Mannas and boatyards CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings • � p ( , less to ground, or exceeds 14,000 ❑ Commercial -use agricultural sL- 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 ❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ", Job no.: 1 Job site address. �J / C 1 ,/� �7 S J I OOHP or more occupancy ❑ R / / Si-) /7 I 0 or more residential units Recreational vehicle parks City /State /ZIP: �J ❑ Health -care facilities ❑ Supply voltage for more than I ''f�fi , Q /Z'e r ❑ Hazardous locations 600 volts nominal Suite /bldg. /apt. no.: I Project name: s / J�, '1// ❑ Service or feeder 600 amps or more l / FEE SCHEDULE Cross street/directions to job site: Desenpiion 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'I 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 Su g I c 2 (J 1" e{ 2 0 r� e- �o ZOO 0 , residential (with above sq ft ) J Services or feeders installation, alteration, and /or relocation 200 amps or less i 100 70 / vQ, 7O2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133 56 2 401 amps to 600 amps 200 34 2 Name: ./L) IS - 1 - e, W l / U ' OCn✓y./0" 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 I ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name. B Fee for bmnch circuits without service or feeder fee, first 56 18 2 Contact name: branch circuit Each add'I bmnch 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 Business name' /� %� � T panel, alteration, or extension Page 2 2 t f - ` b /' LJ-.) f . Each additional inspection over allowable in any of the above Address: J o 2 6 9Z Additional inspection (1 hr min) 66 25/ hr City /State /ZIP: e/ /� Investigation (1 hr min) 66 25/ hr /9n ta l&5 1 O 2 e.. Industrial plant (1 hr min) 78.18/ hr Ls. Phone: ( ) 7v �! ' R Fax: (' ���) '6� j l0 / b Inspections for which no fee is 90 00/ hr �� specifically listed (A hr min) v CCB Lie.: I 7 50 r , Electrical Lic.:e_ 3 Su I- v. Lie.: ?, 5. ELECTRICAL PERMIT FEES Suprv. Electrician sin rt', 1 uired: / 1 Subtotal. / 06 , 7 0_ p g q Al /4.1 _ .... .a i S Pl an review (25% of permit fee) Print name pm"-2 l e _ i` // Date:O-t .r / / State surcharge (12% of permit fee)' i' , 0 TOTAL PERMIT FEE i �( �'th' 8 Authorized signature: This permit application expires if a permit is not n d wi m 1 0 Print name Date: 0 days after it has been accepted as c te. Number of inspections allowed per permit 11).:7Y i \B uildingTermits\ELC- PermitApp doc 07/01/10 440 4615T(I I /05 /COM /WEB Electrical Permit Application FoR,OFFICF.USE ONLY ' City of Tigard �• Date /Bed Q ', Permit No q 13125 SW Hall Blvd , Tigard, OR 97 � - - . . CY Plan Review ' 9 , ._ Phone' 503.718.2439 Fax: 503.598. + , Other Permit Inspection Line 503 639 4175 � - %\\ Date/By Ready/By funs El See Page 2 for TfG'AI D p Internet www ttgazd or.gov OC, 20 Notified/Method Supplemental lementalInformation 1'' TYPE OF WOR i K (� S o 1', � Sl � PLAN REVIEW ❑ New construction ❑ Addition/alteratiot>xr� a t Please check all that apply (submit 2 sets of plans w /items checked below) ❑ Demolition ❑Other: �‘ w ❑ Service or feeder 400 amps or more CI Building over three stories where the available fault current ❑ Mannas 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 ❑ 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 ", "] -3 ", Job ri0 : Job site address: n yy 1 OOHP or more occupancy f� .SW C ) M " -tV2t 0 Six or more residential units 0 Recreational vehicle parks City /State /ZIP: ❑ Health -care facilities ❑ Supply voltage for more than 7 0 Hazardous locations 600 volts nominal Suite/bldg. /apt. no.: I 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: I 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 DESCRIPTION OF WORK (with above sq ) 75.00 2 ft Limited energy, multi- family 75 00 2 / ...' r residential (with above sq ft ) t � ` T * At 11`.. Services or feeders installation, alteration, and/or relocation 200 amps or less l 100.70 2 ❑ PROPERTY OWNER I ❑ 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 Temporary services or feeders installation, alteration, and /or City /State /ZIP: relocation Phone: ( ) I 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, per 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'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: ( ) I Fax: : ( ) Reconnect only 67 84 2 Pump or irrigation circle 67 84 2 E -mail: Signor outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: panel, alteration, or extension Page 2 2 Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66 25/ hr City/State/ZIP: investigation (1 hr min) 66 25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: ( ) I Fax: ( ) Inspections for which no fee is 90.00/ hr specifically listed (,' hr min) CCB Lie.: I Electrical Lie.. I Suprv. Lie.: ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: o Subtotal: lad 7n / Plan review (25% of permit fee). Print name: Date: State surcharge (12% of permit fee) f Oa' // TOTAL PERMIT FEE. t "7 S( Authorized signat / �� This permit application expires if a permit is not obtained within 180 Print name: Date: /A --G --// # days after it has been accepted as complete. Number of inspections allowed per permit 1 \Budding\Permits\ELC- PermitApp doe 07/01/10 440- 4615T(I 1/05 /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 n Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* n Vacuum Systems* n 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 n Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC ❑ Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I \Bmldmgpermus\ELC- PermitApp doc 07/01/10