Permit CITY OF TIGARD ELECTRICAL PERMIT
`• I .•. COMMUNITY DEVELOPMENT
Permit #: ELC2011 -00652
13125 SW Hall Blvd., Ti OR 97223 503.718.2439 Date Issued: 11/18/2011
TIGARD Parcel: 1S134AB90131
Jurisdiction: TIGARD
Site address: 11283 SW SPRINGWOOD DR
Project: Freddie Mac Subdivision: SPRINGWOOD VILLAGE CONDO Lot: 13
Project Description: Reconnect
Contractor: OWNER Owner: FREDDIE MAC
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 11/18/2011 $67.84
Specifics:
1 ea 12% State Surcharge - 11/18/2011 $8.14
Electrical
Type of Use: SF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes an. - 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, • if wo is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cen -r. Thos- rules are set forth in OAR
952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling • r 1.232.1 • 7 0 1.800.33 '44.
Issued By: Permittee Signature: a .. /1—_it
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 Application , E , .: _ __.. _F.OR_OFEICE_USE:ONLY - -- __
1,11 CI of Tigard �" R eceived /
`J g t fJ ,a,., l Date/By: / / / /k /�/ /�, Permit No.:�G��O�I O./26 5-.2, 131 25 SW Hal Blvd., Tigard, OR 97223 Plan Review
C .: Phone: 503.718.2439 Fax: 503.59 Ivu 8 6t Date
By: Other Permit:
' -i 8 2011
T LG A R D Inspection Line: 503.639.4175 Date Ready/F3 uri� y: J 10 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: 776--- Supplemental Information
/S IT!/ P1G' TiPgn;,,r.,
TYPE Or I W t O ,RK n :
',. PLAN REVIEW
eration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ❑ Additiorl/alr
❑ 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "1 -3 ",
IOOHP or more. occupancy.
Job no.: Job site address: I \24:6 $ S1?' R l .WC.IC Da ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: k — T 2 , x D-.2--3 ❑ Health-care a dur locations. ❑ Supply volts voltage for more than
� V l ❑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: fi e s 7-7501r 1 5P 2 /i,. D �2- 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 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family 75.00 2
RE — Co - liken EC. t' - U/FCAAA l Lt r4 residential (with above sq. ft.)
n Services or feeders installation, alteration, and/or relocation
` 3Q -6O K .�' k'e 200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: ^ �—� /, 401 amps to 600 amps 200.34 2
"K, T A (( `IU 12- 601 amps to 1,000 amps 301.04 2
Address: ? .0 . — f)D SI D Over 1,000 amps or volts 552.26 2
� Wo_o p / �� q-9-0.56 Temporary services or feeders installation, alteration, and /or
Ci ty /State /ZIP:
relocation
Phone: ('cr, ) 5 — // . Fax: (S'p3 ) q< — /. --S y 200 amps or less 59.36 l
201 amps to 400 amps 125.08 2
Owner installation: This installation is ,e ng lade on property that I own which is not
9 401 amps to 599 amps 168.54 2
intended for sale, lease, re ore han:.e, accore ing to ORS 447, 449, 670, nd 7Q 1
��tl Branch circuits - new, alteration, or extension, per panel
Owner signature: I Date: \\ k `b \\ A. Fee for branch circuits with
❑ APPLIC NT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name:
B. Fee for branch circuits without
I 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
ty dwelling, service and/or feeder
Phone: ( ) Fax:: ( ) Reconnect only / 67.84 (p7.' ( 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: panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (% hr min)
CCB Lic.: Electrical Lie.: Suprv. Lie.: . ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee):
�� TOTAL PERMIT FEE: /25 . 9�
Authorized signature: vv 0
This permit application expires if a permit is not obtained within 180
p Date: ` days after it has been accepted as complete.
Print name:
L � r \� ( \` l \ I Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(I1/05 /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*
❑ Other:
COMMERCIAL WORK ONLY:
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
n HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \ Building \Permits\ELC- PermitApp.doc 07/01/10