Permit CITY OF TIGARD ELECTRICAL PERMIT
f''' COMMUNITY DEVELOPMENT Permit #: ELC2011 00570
Date Issued: 10/13/2011
TIQARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S110DD90592
Jurisdiction: Tigard
Site address: 10840 SW MEADOWBROOK DR 59
Project: Taylor Subdivision: SUMMERFIELD BROOKSIDE CONDO Lot: 59
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: MF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports (Conditions)
A
This permit is issued to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other app cable I -w All work will
be done in ac - •ance with appr. ed plans This permit will expire if work is not started within 180 days of issuance, or if work is sus 'ended f.r more the 180
days ATTE ION Oregon law re. ices to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952- 001 -00 I through *AR 952 - 001 -0090 Y may tai a copy of the rules or direct questions to OUNC by calling 503 23:.1 or 1 811 332 2344
p k Issued B • Permittee 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:
CONT CT R 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 ON .
City of Tigard Dat /B d �0 �� m e Permit No Y/' oo5 TQ
v 13125 SW Hall Blvd ,Tigard, OR 97223 Plan Review
Phone: 503.718 2439 Fax 503.598 1960 Date/By Other Permit.
TI.GARD Inspection Line: 503.639.4175 Date Ready/By lures' ® See Page 2 for
Internet www tigard - gov Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
El 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 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial El Accessory building amps for all other installations buildings
❑ Multi- family El 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 ", "I -2 ", "l -3 ",
Job no.: Job site address: 1 C^5 Six or or more occupancy
�� 5 t V\�01R:�� ❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: — Z V•� q ❑ Health -care facilities ❑ Supply voltage for more than
/ .1 / I ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: J� /01Z- ❑ Service or feeder 600 amps or more Ar 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'I 500 sq ft or portion 33 92 1
Tax map /parcel no.: Limited energy, residential
75 00 2
DESCRIPTION OF WORK (with above sq ft.)
� Limited energy, multi -family 75 00 2
/G l,= l~TG residential (with above sq ft )
Services or feeders installation, alteration, and /or relocation
200 amps or less 100 70 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133 56 2
Name: &Ear -4-y/ 401 amps to 600 amps 200 34 2
601 amps to 1,000 amps 301 04 2
Address: ?, C) , &d x Sig' Over 1,000 amps or volts 552 26 2
�i T v � Temporary services or feeders installation, alteration, and /or
4...
City/State /ZIP: 7a� f ,, 07j_ `7 SC.p relocation
Phone: 5'63 ) .I9 — / / 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 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 ❑ 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'l 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 J� 67 84 � �f' 8 p 2
Pump or irrigation circle J � 67 84 e / 2
E 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 (1 hr min) 66 25/ hr
Industrial plant (I hr mm) 78 18/ hr
Phone: ( ) Fax: ( ) inspections for which no fee is
specifically listed (1/4 hr min) 90 00/ hr
CCB Lie.: Electrical Lie.: Suprv. Lie.: ELECTRICAL PERMIT FEES
Subtotal: (7, Q"
I
Suprv. Electrician signature, required: Plan review (25% of permit fee) -------- Print name / Date. State surcharge (12% of permit fee): S • /y
G / - TOTAL PERMIT PEE ( 8'
Authorized si g natu This permit application expires if a permit is not obtai d it q hin 180
Print name: /, ) days after it has been accepted as complete.
� - 7 - 4
/
Date: /0 / * Number of inspections allowed per permit
1 \ Building \Permts\ELC- PermitApp doc 07/01/10 440- 4615T(I 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:
n 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
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Buddmg\Permits\ELC- PermttApp doc 07/01/10