Permit CITY OF TIGARD ELECTRICAL PERMIT
'.` ' COMMUNITY DEVELOPMENT Permit#: ELC2012 -00121
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/28/2012
Parcel: 1 S136CA02201
Jurisdiction: Tigard
Site address: 10940 SW 79TH AVE
Project: Smith Subdivision: MARG TERRACE Lot: 1
Project Description: Reconnect for grounding due to water line replacement.
Contractor: FRAHLER ELECTRIC CO Owner: SMITH, SCOTT L & STEPHANIE C
11860 SW GREENBURG RD 10940 SW 79TH AVE
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 639 -4627 PHONE:
FAX: 503 - 639 -4673
FEES
Quantity Description Date Amount
1 ea Reconnect Only 02/28/2012 $67.84
Specifics:
_ 1 ea 12% State Surcharge - 02/28/2012 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
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 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. ATTENTIO regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 rough OA 952- -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: Permittee Signature: / C
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
i%
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 Aaulication
•
FOR OFFICE USIAONEV
City of Tigard • Received ��
° 13125 SW Hall Blvd., Tigard, OR 97223 DateB G1i�1 /i�� Permit No.: 61 Qa /
' Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
0
T 1 G A R D Inspection Line: 503.639.4175 Date/By: Other Permit:
Internet: www.tigard- or.gov Date Ready/By: kris: I 0 See Page 2 fo
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Notified/Method: Supplemental In formation
TYPE OF WORK
❑ New construction PLAN REVIEW 1
® Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
Where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION
exceeds 10,000 amps at 150 volts or
® 1 - and 2 family dwelling 0 buildings.
g ❑Commer /industrial Accessory building less to groun or exceeds 14,000 ❑ Commercial-use agricultural
❑ Accesso buildin
amps for all other installations. buildings.
❑ Multi 0 Master builder
❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or •
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived systen
Job no.: 69238 Job site address: 10940 SW 79' AVENUE Addition of new motor load of p °E•' ` I.2 ", "I - ",
I OOHP or more. occupancy.
•
City/State/ZIP: TIGARD, OR 97223 ❑Six or more residential units. ❑Recreational vehicle parks.
❑ Health-care facilities. ❑ Supply voltage for more than
—
Suite/bldg. /apt. no.: Project name: SMITH RESIDENCE El Hazardous locations. 600 volts nominal.
❑ Service or feeder 600 amps or more
Cross street/directions to job site: FEE SCHEDULE f
Description I Qty. I Fee, I Total 1 •
New residential single- or multi - family dwelling unit.
Subdivision:
Includes attached garage.
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
Limited energy, I
DESCRIPTION OF WORK gys residential 75.00
(with above sq. ft) 2
GROUNDING PANEL DUE TO WATER LINE REPLACEMENT Limited energy, multi - family
residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
IEN
❑ PROPERTY OWNER ' 200 amps or less 100.70
2 , El Name: t. 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( )
I Fax: ( ) 200 amps or less 59.36
Owner installation: This installation is being made on property that I own which is not 1
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
1 68.54 2
Owner signature: Branch circuits — new, alteration, or extension, per panel
Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7 2
Business name:
DATE ENTERED?l _//Z B. Fee for branch circuits without
Contact name: service or feeder fee, first
AcrT _ branch circuit 56.18 2
Address: Each add'I branch circuit 7.42
• 4._ - --- Miscellaneous (service or feeder not included) 2
Each manufactured or modular
City/State/ZIP: DATE PAID: - /IV
Phone: ( ) dwelling, service and/or feeder 67.84 2
CHECK # :_ (___ _ ) Reconnect only 1 67.84 67.84 2
E - mail:
RY• G J 1 Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: FRAHLER ELECTRIC COMPANY Signal circuit(s) or limited energy
panel, alteration, or extension. Page 2 2
Address: 11860 SW GREENBURG ROAD Each additional inspection over allowable in any of the above
Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: TIGARD, OR 97223 Investigation (1 hr min)
66.25/ hr
Phone: (503) 639 Industrial plant (I hr min) 78.18/ hr
I Fax: (503) 639 - 4673 Inspections for which no fee is
CCB Lic.: 37410 I Electrical Lic.: 34 -I3C Suprv. Lic.: 5110S specifically listed (Ys hr min) 90.00/ hr
Suprv. Electrician signature, required: ELECTRICAL PERMIT FEES
Subtotal: . 67.84
Print name: ADAM ETHERMGTON Plan review (25% of permit fee):
Date: 02/28/12 — State surcharge (12% of permit fee): 8
Authorized signature: TOTAL PERMIT FEE: 75.98
Print name: This permit application expires if a permit is not obtained within 180
I Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
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