Permit CITY OF TIGARD ELECTRICAL PERMIT
11 1. COMMUNITY DEVELOPMENT Permit #: ELC2011 -00655
Date Issued: 11/23/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Parcel: 2S 111 DB08600
Jurisdiction: Tigard
Site address: 15410 SW OAKTREE LN
Project: Moy Subdivision: SUMMERFIELD NO.10 Lot: 547
Project Description: Replace (1) 200 amp electrical panel
Contractor: FRAHLER ELECTRIC CO Owner: MOY FAMILY TRUST
11860 SW GREENBURG RD BY MOY, ALTHEA R TR
TIGARD, OR 97223 15410 SW OAKTREE LN
TIGARD, OR 97224
PHONE: 503 - 639 -4627 PHONE:
FAX: 503 - 639 -4673
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 11/23/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 11/23/2011 $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 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 52 -011 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: a / Permittee Signature: QN /9 - 1 3 / 1° 2-• / el9
•
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 RECEIVED . .
•
FOR OFFICE USE ONLY
City of Tigard NOV Received / O
Date /By: // 02i // 1. �% C
Iti .1
r C.. /� ./ 0, ! ,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Permit /
,I {� 2011 2
-
Phone: 503.718.2439 Fax: 503.598.19 Date /B : Other Permit:
T tGARD` Inspection Line: 503.639.4175 �i OF TIGARD Date Ready /By: • ® See Page 2 for
t ?:: Internet: www.tigard- or.gov Supplemental Information
BUILDING DIVISIO Notified/Method:
' .a K€ n ,z" 'N2 # mow
lYl'L OF W ORT. < . PLAN RFIEW 3 �
� -b a_ -r•x � � .... "�< _ ,� ", �;:� a �' .4.;,,,
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ® Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
4Z. 'CATEGORY - - CpNSTRtf C TION r� #� �-1 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
r • - ❑ Emergency system. larger separately derived system :7 if a == �ZTOB "SITE ii∎r o ticA'f O
L . ,. � ,, � � � -� ,- a._ _ - -� ❑ Addition of new motor load of ❑ "p > °E °<1_� a1.3
Job no.: 68990 Job site address: 15410 SW OAK TREE LANE IOOHP 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: MOY RESIDENCE ❑ Service or feeder 600 amps or more
- AF°EEf$LHEDCIE
Cross street/directions to job site: Description I Qty. i Fee. I Total
New residential single- or multi - family dwelling unit.
Includes.attachcd 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
gY,
u n
' i jitT:S P 41ONr�O f ` - (with above sq. ft.) 75 00 2
Limited energy, multi - family
REPLACE ELECTRICAL PANEL residential (with above sq. ft.) 75 I 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 1 100 70 100 70 2
' ' .;r - " 201 amps to 400 am
�PRUP�ItfiY�QWNER�' •_� �TENA T � � �_. � 2 amps 133 56 2 P P
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
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
- 'AP LICA _ t 4 i E Imo" above service or feeder fee,
F Yz� :.. °;,Eg each branch circuit 7.42 2
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)
Each manufactured or modular
City/State /ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E Sign or outline lighting 67.84 2
r aghasfizow -.so tidz��a . _,ate ���� Signal circuit(s) or limited
Business name: FRAHLER ELECTRIC COMPANY panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 11860 SW GREENBURG ROAD
Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: TIGARD, OR 97223 investigation (1 hr min) 66.25/ hr
. Industrial plant (I hr min) 78.18/ hr
P ne: (503) 639 - 4627 Fax: (503) 639 - 4673 Inspections for which no fee is specifically listed ( 90.00 / hr
/ % hr min)
CCB Lic.: 37410 Electrical Lic.: 34 - 13C ''�Suprv. Lic.: S110S I/ e, EtE RICAEEFE121V1CT FEES
A,
Suprv. Electrician signature, required: L
Plan review (25% Subtotal: 100.70
/o of permit fee):
Print name: ADAM ETHERINGTON Date: 11/21/11 State surcharge (12% of permit fee): 12.08 !r, ,,, ,
TOTAL PERMIT FEE: 112.78
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
t.\ Building \Permits\ELC- PermitApp doe 07/01/10 440- 4615T(I1 /05 /COMM'EB