Permit 741 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00580
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 10/19/2011
Parcel: 25111 BA02000
Jurisdiction: Tigard
Site address: 9875 SW VIEW TER
Project: Feller Subdivision: INGEBRAND HEIGHTS Lot: P -55
Project Description: (1) feeder and (1) branch circuit
Contractor: VALLEY 5 ELECTRICAL SERVICES LLC Owner: FELLER, DONALD C & MARY
PO BOX 17932 9875 SW VIEW TERRACE
SALEM, OR 97305 TIGARD, OR 97223
PHONE 503 - 910 -2974 PHONE.
FAX•
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 10/19/2011 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 10/19/2011 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 10/19/2011 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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 OA' • 2- 001 -0090 You ma obtain a cosy of the =erect questions to OUNC by calling 503 232 1987 or 1 800 332 2344 die
Issued By: �� _ _ _ �' 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.
Electrical Permit Applicatio> EcElvED . , . � FOR OFFICE USE' ;y�
Ot -
Received
14 City of Tigard Received 'I Permit No . j � jl — C7t � 7 ��C�
"° 13125 SW Hall Blvd. Tigard, OR 97223 OCT 17 2011 Review
f"
2 . Phone. 503.718.2439 Fax: 503.598.1960
Plan Other Permit. V . /L � ) - •) 9
Inspection nspection Line: 503.639.4175 Ready/By ® Page 2 for
CI CAF TPGA N N ot Notified/Method: r� Supplemental Information
Internet: www.tigard- or.gov PP
BUY D!NG DIVISION ..
TYPE OF WORK . pLAN REVIEW
CI 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
® 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 AAND J LOCATION ❑Emergency system larger separately denved system.
❑ Addition of new motor load of ❑ "A ", "E ", "l - ", "I - ",
Job no.: 11 - 1441 Job site address: 9875 Seu4hwest View Ct 100HP or more occupancy.
❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: Tigard /OR/97224 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: Zins acement fG /k ❑ 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'I 500 sq ft. or portion 33 92 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WOR (with above sq ft.) 75 00 2
Limited energy, multi- family 75.00 2
Replace Zinsco load centers to BR. residential (with above sq. ft )
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100 70 100 70 2
® PROPERTY OWNER . - ❑ , TENANT 201 amps to 400 amps 133.56 2
Name: Don Feller 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 9875 SW View Ct Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: Tigard /OR/97224 relocation
Phone: (503)747 -9856 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 cifetiits with
® 'APPLICANT ❑ CONTACT PERSON above service o fe d er fe 1 7.42 7 42 2
each branch circuit
Business name: Valley 5 Electrical Services B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Daniel Wolf branch circuit
Each add'l branch circuit 7.42 2
Address: PO Box 17932 Miscellaneous (service or feeder not included)
City/State/ZIP: Salem /OR/97305 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 910 - 2974 Fax: : ( ) Reconnect only 67 84 2
Pump or irrigation circle 67.84 2
E - mail: Daniel @valley5elec.com
Sign or outline lighting 67.84 2
CONTRACTOR Signal circutt(s) or limited- energy
Business name: Valley 5 Electrical Services panel, alteration, or extension Page 2 2
Each additional inspection over allowable in any of the above
Address: PO Box 17932 Additional inspection (1 hr mm) 66 25/ hr
City /State /ZIP: Salem /OR/97305 investigation (t hr mm) 66.25/ hr
Industrial plant (1 hr mm) 78 18/ hr
Phone: (503) 910 - 2974 Fax: ( ) Inspections for which no fee is 90.00/ hr
specifically listed CZ hr mm)
CCB Lic.: 185932 •2 j 7 / � Electrical Lic.: C480 7 A Suprv. Li : 575 -- ! 01 I /3 ELECTRICAL PERMIT FEES
J� 1 Subtotal: 108.12 1 /I -
Suprv. Electrician signature, required: / /� Plan review (25% of permit fee): --
Print name: Daniel J. Wolf t // Date: 10/13/2011 State surcharge (12% of permit fee) ' 1 17
TOTAL PERMIT FEE: 1 d,.1 . 01
Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit
1 \Building\Permits\ELC- PermmApp doe 07/01/10 440- 4615T(11/05 /COM/WEB