Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00701
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/14/2011
Parcel: 2S 101 AB00301
Jurisdiction: Tigard
Site address: 7085 SW ELMHURST ST
Project: Nadri Subdivision: 1996 -024 PARTITION PLAT Lot: 2
Project Description: Replace electrical panel and add circuits downstairs.
Contractor: FALCON ELECTRIC Owner: NADRI, KEN
2375 SW CEDAR HILLS BLVD 7085 SW ELMHURST
PORTLAND, OR 97225 TIGARD, OR 97223
PHONE: 503 - 799 -3451
HONE: 503 - 208 -4709
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 12/14/2011 $100.70
Specifics: amps or less
7 crt Branch Circuits w /Purchase 12/14/2011 $51.94
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 12/14/2011 $18.32
Electrical
Type of Const:
Occupancy Grp:
Total $170.96
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 acc• • - • - ith 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. ATT. 1 TION: Oregon law re• ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0.110 thr∎ugh OAR 952 -10 - 0090.• may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800. '344.
Issued :y: Permittee Signature: id/ /'/.�'
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'
A.
Date: /_ A //
LICENSE NO. S
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.
y' "
Electrical Permit Applica #t 1 cFilirr
. FOR OF FICE USE ONLY
City of Tigard Received Permit No.: /
ilii ° 13125 SW Hall Blvd., Tigard, OR . 9 �'n Plaie / z / y 1/
n Review
�� a�l 7�
1l ' Phone: 503.718.2439 Fax: 503.5':. +,0 4 2011 Date/By: Other Permit:
TI G A RD Inspection Line: 503.639.4175 OF Date Ready/By: runs: ® See Page 2 for
C ITY TIGARD www.tigard - or.gov � r Notified/Method: Supplemental Information
TYPE 511'' RIC F DIVISIt 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 ❑ 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
® I- 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 ", 'l -3 ",
Job no.: Job site address: b ,,,- s� �� � Six or or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
Cl /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
City 1 ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: 7-a Pl, GR FEE SCHEDULE
J Qr� Descri ption 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.)
� D , �_ d ( n / o Limited energy, multi - family 75.00 2
f � `ee� t ,'c. J. po._t i (ird aaot t^ i rc.-� r) residential (with above sq. ft.)
r Services or feeders installation, alteration, and /or relocation
d e . t S7 - d - ` rS." 200 amps or less ' 100.70 /0.7C 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: C T ] Ater 601 amps to 1,000 amps 301.04 2
Address: 30 i S =C S � el /e5r Over 1,000 amps or volts 552 26 2
� Temporary services or feeders installation, alteration, and /or
City/State /ZIP: 7? g *4, ex p Q l ? Z - relocation
Phone: 7 99 c 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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
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 4 7.42 57•CY 2
each branch circuit
_ B. Fee for branch circuits without
Business name:
�� � : G7YZ - service or feeder fee, first
56.18 2
Contact name: A t "- [2 , �- t� branch circuit
!'�" Each add'I branch circuit 7.42 2
Address: 23'75 .0 J C-E , /ets ti ✓u7 Miscellaneous (service or feeder not included)
Each manufactured or modular 67 84 2
City /State /ZIP: 7 et"? 93-z s dwelling, service and/or feeder
Phone: (93 ) 2 e.17 O Ct Fax: : ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: S G pt,t .. e CO. e ^ Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: �,qq,, � (( panel, alteration, or extension. _ Page 2 2
t ?ire e ti� C7 ;72-- t e Each additional inspection over allowable in any of the above
Address: �3 W ST-A-) C-f R ,4/ _f Additional inspection (1 hr min) 66.25/ hr
y�� (� i Investigation (1 hr min) 66.25/ hr
City/State /ZIP:
P�27-Let...) p v, ` / ' ZZ S Industrial plant (1 hr min) 78.18/ hr
Phos e : ) Fad Inspections for which no fee is
if[il �� 97 !� //5! ) AVi lI ? specifically listed (%s hr min) 90.00 / hr
CC13 Lie.: 6' :,?_6 Electrical Lie.: C7 3,/ Suprv. Lic.: 485 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: / 5a• 44
Plan review (25% of permit fee):
Print name: 5 z . ....DTr — J�,� OR Date: 12/� / / 1 State surcharge (12% of permit fee): /g • 31
Authorized signature: /f -/ l TOTAL PERMIT FEE: / 7p. 90
g -Y'(� v� = This permit application expires if a permit is not obtained within 180
% / days after it has been accepted as complete.
Print name: .-c_,„(9,7"— /j -P/`�2t-`I • Date: * Number of inspections allowed per permit.
I:\ Building \ Permits \ ELC- PermitApp.doc 0 440- 4615T(t l /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*
n Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n 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
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Budding\Permits\ELC- PermitApp doc 07/01/10