Permit CITY OF TIGARD ELECTRICAL PERMIT
II If Permit #: ELC2011 00571
COMMUNITY DEVELOPMENT
13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 10/13/2011
TiGARI Parcel: 2S102AB00905
Jurisdiction: Tigard
Site address: 12060 SW LINCOLN AVE
Project: Taylor Subdivision: KIMBERLY ADDITION Lot: 5
Project Description: Electrical reconnect
Contractor: Owner: TAYLOR, MICK
PO BOX 518
SCAPPOOSE, OR 97056
PHONE:
PHONE 503-539-1117
FAX
FEES
Quantity Description Date Amount
1 ea Reconnect Only 10/13/2011 $67 84
Specifics:
1 ea 12% State Surcharge - 10/13/2011 $8 14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75 98
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 othe a. •'cable 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 s sus!): ded for more the 180
days ATTENTI• • Oreg• - law requires you to follow the rules adopted by the Oregon Utility Notification Center. Tho rules - e set forth in OAR
952- 001 -0010 rou•h OAR 95 001 -08= r Yo ay obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 •r 1 800 • 2344.
Issued By /L. _ . �L�Lt Permittee Signature: V .
N _ v
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:
CONTRA T 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 O
Received tp ^iy' h 7
1111) City of Tigard Date
B lo AEi� Permit No �� /-fi1/ / / /
13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
P hone 503.718.2439 Fax. 503.598.1960 Date/By Other Permit
TI G A R D Inspection Line: 503.639.4175 Date Ready /By Juris ® See Page 2 for
Internet: www.ttgard- or.gov Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction El 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 El 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 -2 ", "l -3 ",
/ 100HP or more occupancy
Job no.: Job site address:
6206,0 64., t CD(.,/ 4t/E. ❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: ` El Health-care facilities. ❑ Supply voltage for more than
�' (�,) / ❑ Hazardous locations 600 volts nominal
Suite /bldg. /apt. no.: Project name:' name:—/-4.yark ❑ 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 l
Tax map /parcel no.: Limited energy, residential 75 00 2
DESCRIPTION OF WORK (with above sq ft )
Limited energy, multi - family 75 00 2
4 '& -T residential (with above sq ft )
Services or feeders installation, alteration, and /or relocation
200 amps or less 100 70 2
Er/PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133 56 2
Name: y�J// - ?.� 401 amps to 600 amps 200 34 2
/17L < � 4- / /V 601 amps to 1,000 amps 301 04 2
Address. p, p. c S Over 1,000 amps or volts 552 26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP:5 ?? , 072 q70 S relocation
Phone: (3-13) 5 ,"-. /71 -7 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
above service or feeder fee,
❑ APPLICANT ❑ CONTACT PERSON 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)
Each manufactured or modular 67 84 2
City /State /ZIP: dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67 84 (, 7 Q 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
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66 25/ hr
City /State /ZIP: Investigation (I hr min) 66 25/ hr
Industrial plant (1 hr min) 78 18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed ('/z hr min) 90 00/ hr
CCB Lie.: Electrical Lie.: Suprv. Lie.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal 6 7, gy
Plan review (25% of permit fee) - . -----.
Print name: Date: State surcharge (12% of permit fee). $, /C
a
Authorized signature- TOTAL PERMIT FEE '75. 9 $ re: — d
T his permit application expires if a permit is not obtained within 180
Print name: o �;4< Date: days after it has been accepted as complete.
/ /97/3// / * Number of inspections allowed per permit
1 \ Building \Permits\ELC- PermitApp doc 07/01/10 440- 4615T(I1 /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*
❑ 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
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signahng
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Buildmg\Permtts\ELC- PermitApp doc 07/01/10