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Permit CITY OF TIGARD ELECTRICAL PERMIT 111 1. COMMUNITY DEVELOPMENT Permit #: ELC2012 -00034 TEGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/19/2012 Parcel: 2S103CB09700 Jurisdiction: Tigard Site address: 12290 SW QUAIL CREEK LN Project: WYATT Subdivision: QUAIL HOLLOW - EAST Lot: 55 Project Description: Kitchen remodel. Contractor: CHEROKEE ELECTRIC CO Owner: WYATT, COREY R 13211 SW SUMMERWOOD DR 12290 SW QUAIL CREEK LN TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503 - 209 -9039 PHONE: FAX: FEES Quantity Description Date Amount 9 crt Branch Circuits wo /Purchase 01/19/2012 $115.54 Specifics: Service or Feeder 1 ea 12% State Surcharge - 01/19/2012 $13.86 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $129.40 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 throu• • e , ` "v2- 001 -0090. You may obtain a co• of the rules or direct questions to OUNC by calling 503. .1987 or 1. 0.332. :' 4. 11111111111110 - Issued By: mittee Signature: '""`— t 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 FOR OFFICE USE ONLY City of Tigard ��� Received Permit No.: �, _ �. 13125 SW Hall Blvd., Tigard, (!J Plan R g I ^ Plan Review ' 1 . Phone: 503.639.4171 Fax: 5 i4` :.1960 n (0.- Other Permit: '1' 10 A IM` Inspection Line: 503.639.41 -75 A , �� Date Ready/By: ®See Page 2 for Internet: www.tigard- or.gov ,P v '� 1C3r� Notifi Supplemental Information TYPE OF {v i 1 0 IO � �� �� 5\ ® 1 PLAN REVIEW ❑ New construction Addition/altf`,, acement Please check all that apply (submit 2 sets of plans w /items checked below): V v' ❑ Service or feeder 400 amps or more 12 Building over three stories. ❑ Demolition ❑ Other: B 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 JOB SITE INFORMATION AND LOCATION ❑ El A Addition of system. larger separately derived system. ddition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", �"�" OOHP or more. occupancy. Job no.: Job site address: /c,© SI,r� t'�tuu� Cf e>✓IC 1. v► ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: Ti QA V C7l I ` �� ' - zz3 ❑ Health -care facilities. ❑ Supply voltage for more than �1 ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: C ore , / W yet-ft" El Service or feeder 600 amps or more • FEE SCHEDULE Cross street/directions to job site: 5 I ZI 6 £ t 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'I 500 sq. ft. or portion 33.92 1 Limited energy, residential 67.84 2 DESCRIPTION OF WORK (with above sq. ft.) p J Limited energy, multi - family jE '(c._l e44 r✓1/14000e ( p / J l� h t J t 4 5 t rct t l e residential (with above sq. ft.) 67.84 2 / J Services or feeders installation, alteration, and/or relocation reTer - r - eeZt✓i - / -Y Wa nd/11mi &V€ (*\ 200 amps or less 100.70 2 ❑ PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 601 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 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: Branch circuits- new, alteration, or extension, per panel A. Fee for branch circuits with IX APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2 Business name: / each branch circuit �.�-0`c.e� C e -c ._-1- f - L B. Fee for branch circuits / without service or feeder fee, ' 56.18 .1 % 2 Contact name: �� h SGY 1 ✓n ex first branch circuit Address: t 3 ;Z({ su) swim I ie u'�cQ h r Each add'I branch circuit 7.42 ' ', b 2 /� Miscellaneous (service or feeder not included) City /State /ZIP: T ` tp c i 0't' ©k t 7zz3 Each manufactured or modular 67.84 2 J t r� / dwelling, service and/or feeder Phone: (SD 3) 2,0 `t - jo g 7 Fax: : (51 3 ) 3 7 2 _ - 6 l 3 , Reconnect only 67.84 2 E -mail: $cr% vV' r -oiN. E Lt.. 0 I • y l Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 � l� Signal circuit(s) or limited - Business name: N t✓.O k� E1 ex I L energy panel, alteration, or Address: (3 s (.0 S tAby�inA w b r . extension. Describe: Page 2 2 City /State /ZIP: I ` � �,�/ ?' ©1Q ?? 2 .33 Each additional inspection over allowable in any of the above t / ! Per inspection 66.25 Phone: (5 ) ,2j9c(_ c Fax: (5 37,2 - 673 b Investigation per hour (1 hr min) 66.25 CCB Lic.: 35 6 I I Electrical Lic.: 3 - ( z,7 c_ Suprv. Lic.: Volk, 5 Industrial plant per hour 78.18 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: ^� � _ Subtotal: / /3"..54 Print name: ` Date: Plan review (25% of permit fee): v . , S G6" t v VteJr / - t F(- /2... State surcharge (12% of permit fee): /39, / Authorized signature: TOTAL PERMIT FE 1 ; . , 40 Print name: ���"``'�'���`"""�"' "� Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. s Number of inspections allowed per permit. I: \ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 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 .. $67.84 Check Type of Work Involved: n Audio and Stereo Systems* ❑ Burglar Alarm n Garage Door Opener* n Heating, Ventilation and Air Conditioning System* n Vacuum Systems* n Other: COMMERCIAL WORK ONLY: Fee for each commercial $67.84 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls n Clock Systems ❑ Data Telecommunication Installation T1 Fire Alarm Installation n HVAC n Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ 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 \Building\Permits\ELC- PermitApp doc 10/01/09