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Permit 71 4 CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00627 Date Issued: 11/04/2011 TI3ARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 1S135DCO3600 Jurisdiction: Tigard Site address: 11700 SW 95TH AVE Project: Thomas Subdivision: FIRDALE- UNRECORDED Lot: 8 Project Description: (1) 200 amp service. Contractor: COLE HILL ELECTRIC INC Owner: THOMAS, DARWIN 1251 SW CLAY ST 6715 NE 63RD ST #103 -264 DALLAS, OR 97338 VANCOUVER, WA 98661 PHONE: 503 - 999 -1638 PHONE: FAX: 503 - 623 -4945 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 11/04/2011 $100.70 Specifics: amps or less 1 ea 12% State Surcharge - 11/04/2011 $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 i ue s e 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 i accordance with roved 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 A ENTION Oregon law req s you to follow the rules adopted by the Oregon Utility Notification Center T ose rules are set forth in OAR 952 -001 0010 throe h OAR 952 -001 0 Yo y obtain a copy of a rules or direct questions to OUNC by calling , 5 �� 0 03 3 ^ 232 198 r 1 00 332 2344 Issue 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' 4//a/P_■# i - �� .� � 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 Applicati6tp i FOR OFFICE USE ONLY City of Tigard E CE r _ Date /B ,, Permit No. aQ,y --�(v� ° 13125 SW Hall Blvd., Tigard, OR 97224 t1 Plan Review 9 Phone• 503.718 2439 Fax• 503 598 1 bO , U Cl LU I Date /By Other Permit TI G A RD Inspection Line 503 639 4175 Date Ready/By Runs ® See Page 2 for Internet• www.tigard -or gov CITY OF TIGARD Notified/Method. Supplemental Information TYPE O4 DiV6lUI1 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 stones ❑ 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 ❑ Accessory building amps for all other installations buildings El Multi - family ❑ 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 ", "1 -3 ", Job no.: Job site address • irve 1� '4 Sy I or more occupancy ❑ Six x o or r more residential units ❑ Recreational vehicle parks City /State /ZIP: -` ❑ Health -care facilities g ❑ S u PP Y 1 voltage for more than ir;/ ❑ 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 New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq ft or less 168 54 4 Tax map /parcel no.: Ea add'l 500 sq ft or portion 33 92 1 Limited energy, residential 75 00 2 DESCRIPTION OF WORK (with above sq. ft.) . .. / Limited energy, multi - family 75 00 2 -7 -op4 7E' ,-r )r P 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 2 401 amps to 600 amps 200 34 2 Name: ' i 2 r v 601 amps to 1,000 amps 301 04 2 Address: Over 1,000 amps or volts 552.26 2 City /State /ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or less 59 36 I 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 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'I 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 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: l — " Orl �l� � f et, - ri 1 panel, alteration, or extension Page 2 2 r Each additional inspection over allowable in any of the above Address: / Z o 5,,ta! a � ( Additional inspection (1 hr min) 66 25/ hr City /State /ZTP: investigation (1 hr min) 66 25/ hr ( /G� /L, ©'g ! 7l ICJ Industrial plant (1 hr min) 78 18/ hr Phone. ( ) inspections for which no fee is �d 3 ) ��9 ��g Fax: Z 3� specifically listed (% hr mm) 90 00/ hr V COB : f .: /75 Electrical Lie.: e Z cg 1 , J Spprv. Lie.: zf 'MZ / � / l /j ELECTRICAL PERMIT FEES y ! `T /o Subtotal: I SIpri. hlectrician signature, required: �/l� Plan review (25% of permit fee) Print name: O apex, Date:` / State surcharge (12% of permit fee) TOTAL PERMIT FEE. (/ 2. 78 Authorized signature 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 \Budding\Permns\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: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* [1 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 n Intercom and Paging Systems n 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 I \Bu ldmg\Permos\ELC- PermiApp doc 07/01/10