Permit CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit #: ELC2009 -00236
.GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/26/2009
T1,
Parcel: 2S103DD00405
Jurisdiction: Tigard
Site address: r 107,65,SW.EAIRHAVEN ST
Subdivision: Lot: 0
Project: Hulquist
Project Description: Replace 200 amp or less panel.
Owner: FEES
HULQUIST, MARY ANN Quantity Description Date Amount
10765 SW FAIRHAVEN ST
TIGARD, OR 97223 1 ea Services or Feeders - 200 05/26/2009 $80.30
amps or less
PHONE: 1 ea 12% State Surcharge - 05/26/2009 $9.64
Electrical
Contractor:
FRAHLER ELECTRIC CO
11860 SW GREENBURG RD
TIGARD, OR 97223
PHONE: 503 - 639 -4627
FAX: 503- 639 -4673
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $89.94
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 -0100 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
t {��\ CAI
Issued By: Q Y� �C ) Sl JV Permittee Signature: V (It � 4 C_OSki (" A
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 an inspection that business day.
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 ONLY
City of Tigard Rec€ew
1 2009 Pla !> Permit No.: 9 tC�00g - QC
° 13125 SW Ha ll Blvd., Tigard, OR 97223 MAY 2 a
' ' Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: •
T I GA. R D Inspection Line: 503.639.4175 CaTY �`� ��'�f 11 v (F - � - Ready/By: runs: El See Page 2 for
Internet: www.tigard- or.gov N v otified/ethod: Supplemental Information
I ���
MI i ,.. 0 TYPEkit " WORK': .. . `, :': . . , P.I;k14•V - REV ElirO 5 ••
❑ New construction ®Addition /alteration/replacernent 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 0 Other:
where the available fault current ❑ Marinas and boatyards.
-^ ! "= _ ,. , CATEGORY , " , iOF ; CONSTRUCTION :, : .';;; : - ' ; ; `, .,' ' exceeds 10,000 amps at 150 volts or 0 Floating buildings
• less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
I - and 2-family dwelling Commercial/industrial D Accessory building amps for all other installations. buildings. 0 Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
- .; ;JOB ` SITE INFORMATION AND " LOCATION . - . :.. a ', :.., : :
❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E" "1 -2" "1 -3"
Job no.: 65599 Job site address: 10765 SW FAIRHAVEN STREET 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: TIGARD, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: HULQUIST RESIDENCE ❑ Service or feeder 600 amps or more.
FEE
Cross street/directions to job site: Description :SCti> r Qty. :: - .
i Pee. i Total r w
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 75.00 2
- r D OF' WORK ,
•,:, •. , 3, ,, . . .., ,. ,., :...; ; : (with above sq. ft.)
Limited energy, multi - family 75.00 2
REPLACE ELECTRICAL PANEL residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 80.30 80.30 2
< <❑ .PROERTY `OWNER "TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
. __ .. __ .. - . . . . ...- 601 amps to 1,000 amps 240.60 2
Address: - Over 1,000 amps or volts 454.65 2
City /State/7TP: - - • • - • • - • - Temporary services or feeders installation, alteration; and/or
relocation
Phone: ( ) 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
Owner signature: Date: Branch Circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
' ;- " -s .Q LIC ACT O ". above service or feeder fee,
`:
AEP ANT `` ; r] SCONT P N'' ' tj n -
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee 46.85 2
first branch circuit
Address: Each add'1 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
CTO 40 2
'_: - ,.::• R': .> , Sign lighting 53
outline
Signal circuit(s) or limited -
Business name: FRAFR,ER ELECTRIC COMPANY energy panel, alteration, or
Address: 11860 -SW GREENBURG ROAD extension. Describe: Page 2 2
City /State/ZTP: TIGARD, OR 97223 . Each additional inspection over allowable in any of the above
Per inspection --- - 62.50 .
Phone:- _ ne:-( 503) 639 -4627 Fax: ( 503) 639 -4673 Investigation per hour (1 lir.min) , _ 62.50
CCB Lic.: 37410 Elect Lic. 34 -13C Suprv. Lic.: 1816S Industrial plant per hour • 73.75
Su Electrician signature, re '- LECTRICAL.PERIYIITFEES: ,; .,' .__ s.. -
Pr `' : / a7 / h subtotal: 80.30 •
Plan review (25% of permit fee):
Print name: R . W. FRAHLER • Date: 05/19/09 State surcharge (12% of permit fee): 9.64
Authorized signature: TOTAL PERMIT FEE: 89.94
Print name: Date: This p ermit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
.,
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIIDENTIAL `WORE 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:
CO1VIMiERCIALWORONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
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*
❑ 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