Permit •
CITY OF TIGARD ELECTRICAL PERMIT
, o •I Permit #: ELC2011 -00617
- COMMUNITY DEVELOPMENT
. 1312 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 11/03/2011
TIGARD 13125 2S102CD02709
Jurisdiction: Tigard
Site address: 9715 SW OMARA ST
Project: SANCHEZ Subdivision: FREWING'S ORCHARD TRACTS Lot: 28
Project Description: (4) branch circuits for bathroom addition inside detached garage
Contractor: HI DEF ELECTRIC Owner: SANCHEZ, J GUADLUPE
1110 NE 19TH CT ZAVALA, BLANCA E
CANBY, OR 97013 9715 SW O'MARA ST
TIGARD, OR 97223
PHONE. 503 - 891 -2231 PHONE
FAX: 503 - 212 -5516
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 11/03/2011 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/03/2011 $9 41
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87 85
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 acco e wi proved 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 ATTE ON Oregon la require you to follow the rules adopted by the Oregon Utility Notification Center Those rules set forth in OAR
952 - 001 -001 throug OAR 952 -001 $091 You m- •btain a copy of the rules or direct questions to OUNC by calling 503 232 1987 800 332 2344
Issued By. c /#_ ‘i/� —•: — i Permittee Signature: X
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 Date: /( ( � Ail
LICENSE NO.
0/
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 FOR O FFICE USE ONLY .
II City of Tigard Date/By. a g# Permit No • E V1.-4,6!7
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
M , Phone' 503 718 2439 Fax. 503 598 1960 Date/By Other Permit
TIGARD Inspection Line 503.639.4175 Date Ready/By Juris H See Page 2 for
Internet www.tigard - or.gov Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ 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 ❑ 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
14 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 AND LOCATION ❑ Emergency system larger separately derived system
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address 7i5' c 54v 67 /972,,i— 1 or occupancy
❑
❑ Six ix or or more re e reesidential units Recreational vehicle parks.
City /State /ZIP: ❑ Health -care facilities ❑ Supply voltage for more than
—�j ❑ Hazardous locations 600 volts nominal
Suite /bldg. /apt. no.: Project name: `� r/7'3 n ,, f ❑ Service or feeder 600 amps or more
� -I FEE SCHEDULE
Cross street/directions to job site: Description I Qty. l 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
Tax map/parcel no : Ea add'l 500 sq ft or portion 33 92 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq ft ) 75 00 2
Limited energy, multi- family 75 00 2
M O V , rt a ( Rai 4. 4`0 4) 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
/ ` 1 401 amps to 600 amps 200 34 2
Name:
7. J a 1 , f cs .S0.1\1 C Z-- 601 amps to 1,000 amps 301 04 2
Address: [ 7_1 s' S V M Q► t A S+ , Over 1,000 amps or volts 552 26 2
City/State/ZIP: f 1 Temporary services or feeders installation, alteration, and /or
Cit
y T.1 `7 s .rd relocation
Phone: ( ) 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 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 1 56 18 5 j( 2
Contact name: branch circuit
Each add'I branch circuit ` 7j 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: f/ — 0 C F ele a. 1 C panel, alteration, or extension Paget 2
Each additional inspection over allowable in any of the above
Address: CC /0 A (9 1-ii C T Additional inspection (1 hr min) 66 25/ hr
City /State /ZIP: Can ✓ y O 1 ?A , investigation (1 hr mm) 66.25/ hr
Industrial plant (1 hr mm) 78 18/ hr
Phone: (ya7) 8f ( _ 2. 2_3 / Fax: (S ') ). I Z S-r1� inspections for which no fee is 90 00/ hr
specifically listed (%P hr min)
CCB Lie.: 17L 6 Z 2 Electrical Lic. C I Suprv. Lie.: $ ?a 4t-S ELECTRICAL PERMIT FEES ,`'[
Suprv. Electrician signature, required: Subtotal '7g .Y `T
o r�
Plan review (25% of permit fee).
Print name: C (4 r L C 14 01 y Date: i / — 3—// State surcharge (12% of permit fee): q4 5
1 .a n
Authorized signature TOTAL PERMIT FEE: v
Q"
t This permit application expires if a permit is not obtained within 180
Print name: �n f Date: ( days after it has been accepted as complete.
u �J ���Z ` Number of inspections allowed per permit
I.\Building\Permits\ELC- PermitApp doe 07/01/10 440- 4615T(11/05/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*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ 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
n Data Telecommunication Installation
n Fire Alarm Installation
.❑ HVAC •
❑ Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 \Budding\Permits\ELC- PermItApp doc 07/01/10