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Permit o/fivi/ pcvyyvt-' "Aktua CITY OF TIGARD ELECTRICAL PERMIT 1 1 : COMMUNITY DEVELOPMENT Permit #: ELC2011 -00568 Date Issued: 10/13/2011 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Parcel: 1S134CB03700 Jurisdiction: Tigard Site address: 12510 SW SUMMER CREST DR Project: Seaver Subdivision: SUMMER HILLS PARK Lot: 35 Project Description: Service up -grade only 10/18/2011 reprinted the permit to include (1) feeder Contractor: D & L ELECTRIC INC Owner: SEAVER, DEBORA PO BOX 367 12510 SW SUMMER CREST DR WEST LINN, OR 97068 PORTLAND, OR 97223 PHONE: 503 - 656 -5623 PHONE 951- 231 -3157 FAX 503 - 650 -1918 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 10/13/2011 $100.70 Specifics:, amps or less 1 ea 12% State Surcharge - 10/13/2011 $12.08 Type of Use: SF Electrical Class of Work: ALT 1 ea Services or Feeders - 200 10/18/2011 $100 70 amps or less Type of Const: 12 12% State Surcharge - 10/18/2011 $12.08 Occupancy Grp: Electrical Total $225 56 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 accordance 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 ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0090 You may obtain a co• of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344 " �v "^ Issued By: ! � `L� _ r 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: 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. CITY OF TIGARD ELECTRICAL PERMIT 1111 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00568 Date Issued: 10/13/2011 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 parcel: 1S134CB03700 Jurisdiction: Tigard Site address: 12510 SW SUMMER CREST DR Project: Seaver Subdivision: SUMMER HILLS PARK Lot: 35 Project Description: Service up -grade only. Contractor: D & L ELECTRIC INC Owner: SEAVER, DEBORA PO BOX 367 12510 SW SUMMER CREST DR WEST LINN, OR 97068 PORTLAND, OR 97223 PHONE: 951- 231 -3157 HONE: 503 - 656 -5623 FAX 503 - 650 -1918 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 10/13/2011 $100 70 Specifics: amps or less 1 ea 12% State Surcharge - 10/13/2011 $12 08 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 Required Items and Reports (Conditions) This permit is issu -. - t 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 with a.> oved 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 law equi - you to follow the rules adopted by the Oregon Utility Notification Center Those rule are set forth in OAR 952 - 001 -0ri 10 throw 'h OAR 952- 001 -00 -'0 You • obtain a copy of the rules or direct questions to OUNC by calling 503 2 9 or 1 800 ' 32 • a � Issued - -.: . . `te / ■ , Permittee Signature: � 32 ` 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' _ •�` // Date: DAM 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 \'''''(<71111 . O IC E t;S O : : \ ' �� Received ecei - City of Tigard % ti i, iv 13125 SW Hall Blvd., Tigard, d, OR 972- `' ° g� , } • ty�2avtety Permit N.. t O y rya /! t isge 1 Phone: 503.7182439 Fax: 503.598.19. I O C � � `cJ' , •o :fe/Bv: Other Perms: TIGARD Inspection Line: 503.639.4175 °��' .. t e ReadyBy. iuris la See Page 2for • _ Internet: www tigard- or.gov .&-,,\-' r \'' x...,‘" J Notified/Method: Supplemental Information TYPE OF WORK s� \\ .) PLAN REVIEW • ew construction Please check all that apply (submit 2 sets of plans w/items checked below): ❑ Additi on balteration /replace tli nt ❑ Service or feeder 400 amps or more © Building over three stories D ntnolitio n ❑ 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 El Commercial -use agricultural 5I- and 2- family dwelling ❑ Commercial/industrial El Accessory building amps (or all other installations buildings ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system larger separately derived system. rAeSr ❑ Addition of new motor load of ❑ `A ", "E ", "I -2 ",' 1 -3" G• 1001 or more. occupancy Job no.: Job site address/2,520 StA, � .. b. ...6 0 Six or more resident units- ❑ Recreational vehicle parks City/State /ZIP: 4 j71-23 ❑ Health -care facilities CI 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 P i t?n 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 I Tax map /parcel no.: Limited energy, residential 75 00 2 DESCRIPTION OF WORK (with above sq ft.) Limited energy, multi- family L residential (with above sq. ft) 75 00 2 Services or feeders installation, alteration, and/or relocation 210 amps or less f 100 70 Aga) a 2 ict PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 Name: - rll� sock - 401 amps to 660 amps amps 30 04 2 �.J v 60I amps to 1,000 amFs 301 1 04 2 Address: / Z .5" G J i .- s ,,,,.,„ . r ,c".....44, J ,Jt' /)),l Over 1,000 amps or volts 552 26 2 /State /ZIP. �� / Temporary services or feeders installation, alteration, and /or Ci h - 1 i y^4 vlv o71, 1 2 zi relocation Phone: (5 ) 5) 2 J —yz�/ gt' y Fax: ( ) 200 amps or less 59 36 l J 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. Pee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7 42 2 each branch circuit Business name: B. Pee 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 2 dwelling, service and/or feeder Phone: ( ) Far:: ( ) 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: 1/2._ eJ�l,/�-u (.--7.--..Le. panel, alteration, or extension Paget 2 Each additional inspection over allowable in any of the above Address: / 7 C Additional inspection (1 hr min) 66.25! hr City /State /ZIP: 4 f F,""' L / V4-/ d de 7 7 Investigation (I hr min) j 66,25/ hr industrial plant (1 hr min) 7818/ hr Phone: ($e) ) b $' 2' Cz� 1 Fax: fa ) ex. -) 9)6 1 Inspections for which no fee is 9000/ hr specifically listed (A hr min) ` CCB Lie.: ' ?d Electrical Lic.7../ / Suprv. Lie. :24 I ELECTRICAL PERMIT FEES Suprv. Electrician signature, required.A - he Subtotal !• 70 Plan review (25% of permit fee). ----- Print name: J Date: / I State surcharge (12% of permit fee). �d J�A �/r �lP+ t ,k,., �G' 004,1 TOTAL PERMIT FEE. 11/ y 2 . ) g i Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. I Print name: Date: * Number of inspections allowed per permit IiBuildingV 'ermus,ELC-Pennitkppdoe 07;01110 440 £•d 8666)99£09 'out ovpoo i'ga dZ£: 60 6 6 8 6 TOO Electrical Permit Application ` FOR OFF ICL •U ONI v . ', 5' - City of Tigard RECEIVED RDeatceelBved /0® Permit No . � X/ 6-4,1 e '' 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ® Other Permit: Phone: 503.639.4171 Fax: 503.598.1960 3 Date/B "T I G A:45 Inspection Line: 503.639 4175 OCT 1 3 2011 Date Ready/By: Buis ® See Page 2 for Internet: www.tigard - or.gov Notified/Method Supplemental Information TYPE OF W OFTIGARD , .. PLAN REVIEW I:yG DIVISION Please check all that apply (submit 2 sets of plans w /items checked below). ❑ New construction cgrAddition/alterationireplacement ❑ Service or feeder 400 amps or more ❑ Building over three stones ❑ 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 541- 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 ❑ Emergency system larger separately den ved system JOB SITE INFORMATION AND LOCATION ' • • ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 -3 ", /I . IOOHP or more. occupancy Job no.: Job site address: /2.c/0 ❑ Six or more residential units ❑ Recreational vehicle parks. • City/State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than /��a�'y u � Z-Z /� ❑ 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 145.15 4 Ea. add'l 500 sq. ft. or portion 33 40 1 Tax map /parcel no.: Limited energy, residential ' - ' 'DESCRIPTION OF WORK ' , ' . (with above sq ft) 75.00 2 Limited energy, multi- family S 4// CC Istp 61/ ,3.04/.e-- residential (with above sq ft ) 75.00 2 Services or feeders installation, alteration, and /or relocation 200 amps or less / X01*0 A/0;70 2 ,,PROPERTY OWNER . ' ❑, TENANT 201 amps to 400 amps 106.85 2 Name: OA &) S ,_Je`er 401 amps to 600 amps 160 60 2 f 601 amps to 1,000 amps 240.60 2 _ Address: / 7 /U 5 j ��� , C i f ,/ /7/(, Over 1,000 amps or volts 454.65 2 City / State/ZIP 0, ZZI Temporary services or feeders installation, alteration, and /or relocation Phone: ( "7,) [jy = Z, /cL Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 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, each branch circuit 6.65 2 Business name: B. Fee for branch circuits without service or feeder fee, 46.85 2 Contact name: first branch circuit Address: Each add'I branch circuit 6.65 2 Miscellaneous (service or feeder not included) City /State/ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 • CONTRACTOR . ` .. Sign or outline lighting 53 40 2 / � Ca 2 ?-/ Signal circuit(s) or limited - Business name: Dge, cI C.i C.-- energy panel, alteration, or Address: 7,G 4 3,, .--.. extension. Describe: Page 2 2 City/State /ZIP:A4 s. 7✓ 6-iN,Li C41.. • f(((14 Each additional inspection over allowable in any of the above Per inspection 62.50 Phone S-03) e)---4 _r 3 Fax: 64' ) (;5' , — ' 1 / Investigation per hour (1 hr min) 62.50 CCB Lic.: Es-0 c 9 Electrical Lic.:?..../4/6., Suprv. Lie Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: �� Subtotal: /)O. 7e Print name 0 j4 /? ? Z e h eA. I� Date: : 3 , iii Plan review (25% of permit fee) / J f ► ! r / " State surchargete.4) of permit fee): 1 .$ Authorized signature: TOTAL PERMIT FEE: // ✓ 7 _ This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit I \ Building \Permits\ELC- PennmApp doe 05t23/06 440- 4615T(1 I /05 /COM /WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: [ 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- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* n 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 \Buddmg\Permns\ELC- PermiApp doc 03/23/06