Permit it CITY OF TIGARD ELECTRICAL PERMIT
° COMMUNITY DEVELOPMENT Permit #: ELC2011 -00587
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 10/21/2011
Parcel: 2S109DA17900
Jurisdiction: TIGARD
Site address: 15271 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, lot 108 Subdivision: ARLINGTON HEIGHTS NO 3 Lot: 108
Project Description: Install circuit for possible future solar photovoltaic system.
Contractor: HILLSBORO ELECTRIC LLC Owner: STONE BRIDGE HOMES
21185 NW EVERGREEN PKWY #110 16869 SW 65TH AVENUE #505
HILLSBORO, OR 97124 LAKE OSWEGO, 97035
PHONE: 503 - 439 -9666
PHONE 503 - 387 -7577
FAX: 503 - 601 -3680
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 10/21/2011 $56 18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/21/2011 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62 92
Required Items and Reports (Conditions)
This permit is is 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 i accordance 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 TENTION Oregon law eq 'r- you to follow the rules adopted by the Oregon Utility Notifis Center Those rules are set forth in OAR
952 -00 -0010 through OAR 952 X01 -009' Y•u may obtain a cop of the rules or direct questions to OUNC cal .,. r cam_ 2 1987 or 1 800 332 44
Issu By: Permittee Sign e: 4107
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' `�- � I re I "� Date:
if
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 ""` F OR OFFICE USE ONLI � "
1 � ,
City of Tigard /� Recei 1 A 9/7, DD5C -q `J g 4' -.p ly D/B Permit No .C.'� `Or ! O
13125 SW Hall Blvd , Tigard, OR 97223 �. "�, Pl an Review
U PI
� , Permit Phone. 503.718.2439 Fax 503.598.1960 . , Q _Date /B •
Other Perm � DDS
T l G`A'R - Inspection Line 503 639.4175 ® ! Ready /By See Page 2 for
Internet: www.ti and -or ov ' . r Noufied/Method UM Supplemental Information
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TYPE OF WORD@ `J � - ,^ t6 j ` . PLAN REVIEW -
❑ New construction 16Addition /alteration /replacemenfk "� ��r Please check all that apply (submit 2 sets of plans w /items checked below).
r \; ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition El Other: ., \� where the available fault current ❑ Mannas and boatyards
CATEGORY OF CONSTRUCTION ''',i`J exceeds 10.000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
I - 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 derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A "E ' I -2 ", "1 -3 ".
I OOHP or more occupancy.
Job no.: 34 Job site address' `52� ` -51 SJm V ❑Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP i— 22' ❑ Health -care facilities El Supply voltage for more than
i 5
■ O �Z, 1 ❑ Hazardous locations 600 volts nominal.
Suite/bldg /apt. no.' Project name: NI.\ �ek,, 0 Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qn• I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision:
Lot no.: 1,000 sq. ft. or les 168 54 4
Ea add'1500 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
�O fN.- c_:, - ( -bs , te_ LC � residential (with above sq. ft )
Services or feeders installation, alteration, and/or relocation
,L ;'i' l )-e� 200 amps or less 100 70 2
❑ PROPERTY OWNER 1 • '❑ 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: ( ) Fax: ( ) 200 amps or less 59 36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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 (3 CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without yp
service or feeder fee, first I, 56.18 5(e \O 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 2
Pump or irrigation circle 67 84 2
E-mail: Sign or outline lighting 67 84 2
CONTRACTOR Y Signal circuit(s) or limited energy
Business name' Hillsboro Electric, LLC panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 21185 NW Evergreen Parkway #110 Additional inspection (1 hr mm) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: �gacd 1.1.,L( 5 6 6 ,/2 .. 97/01f industnal plant (I hr min) 78 18/ hr
(
Phone: (503) 439 - 9666 Fax: (503 601 Inspections Inspections for which no fee is 90.00 / hr
L �� `r / specifically listed ('% hr min)
v(;CB Lie.• 134481 i3 V lectrical Lic • 4 -499C '�''I ( Suprv. Lie.. 4 6 5 - - ELECTRICAL PERMIT TEES. - _ .
' w"" 1 0 Subtotal SG, • l�
Suprv. Electrician signature, required:
Pla review (25% of permit fee)
Print name: PA V L A • E Lit s Date: 3,7:) . r( State surcharge (12% of permit fee)
TOTAL PERMIT FEE 6 7_, ei'Z
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Pnnt name: Date: * Number of inspections allowed per permit
1 \Building \Permits \ELC- PermitApp doc 07/01/10 440- 4615T(11/05/COM /WEB