Permit II CITY OF TIGARD ELECTRICAL PERMIT
o COMMUNITY DEVELOPMENT Permit #: ELC2012 -00168
T I G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/27/2012
Parcel: 2S110BA03700
Jurisdiction: Tigard
Site address: 11645 SW CLOUD CT
Project: SKOKAN Subdivision: SHADOW HILLS Lot: 28
Project Description: Panel change.
Contractor: QUALITY PLUS FRAMING & ELECTRICAL Owner: SKOKAN, ROBERT & KATHLEEN
16037 SW BOWMEN LN 11645 SW CLOUD CT .
SHERWOOD, OR 97140 TIGARD, OR 97224
PHONE: 503 - 799 -1639 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 03/27/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 03/27/2012 $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 ' ' . - . .b'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do - in accordance wi • •pro . • • ans. 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 la ` requir= u to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 001 -0010 through OAR 95 r r 009y ay obtain a co•, of the rules or direct questions to OUNC by calling 503.232. 87 or 1.8049 2344.
i i
Is ued By: e t� Permittee Signature: X
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' �".------ I I / 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 Foli f1FFlcI List: oN uv
City of Tigard Dace ed NOM Permit No.: / sA�� l � 4
• 13125 SW Hall Blvd., Tigard,OR 97223 MAR 2 7 2012 Plan Review
111111 II Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
1' 1 C. n IZ u Inspection Line: 503.639.4175 CITY O F TIGA Date Ready/By: tuns: ® See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction [► ' Addition/alteration/replacement Please check all that apply (submit a 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
Er._ 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 ", "1 -3 ",
Job no.: Job site address: IOOHP or more. occupancy.
I I c � c k 0 Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: i....--- 1 Or- 0 Health cart facilities.
❑ Hazardous locations. ❑Supply voltage for more than
600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qtr. 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
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
cat'l e.l Gtiar residential (with above sq. ft.)
5 Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 ` 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: D 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: t , 6 Li $' 5" t t/ G 10 N, a. Over 1,000 amps or volts 552.26 2
City/State/ZIP: • a f"' Temporary services or feeders installation, alteration, and/or
�u i 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 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 I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: I B. Fee for branch circuits without
Q fti t; r t� !t%�s Fl fin�' SL L � cc �' �` s o r feeder fee, first
�f 56.18 2
I , / n / , t t t f1 v branch circuit
Contact name: ✓ ✓✓ vv J 6
Each add'I branch circuit 7.42 2
Address: 1 663 7 S w /3 f ,p v , %s. Miscellaneous (service or feeder not included)
City/State/ZIP: J d Each manufactured or modular 67.84 2
ty r[ e /' 1..„..)0 r) C OP- �,� dwelling, service and/or feeder
Phone: ( 503) 791 - 163 7 Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
a d/ / US
Business name: ! �Ypv,t, f panel, alteration, or extension. _ Page 2 2
n �� e G �. c a
Each additional inspection over allowable in any of the above
Address: I bO 3 ? OW g G o y h , e ,, . i , Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: 4 h a g. t)/= dl 7 / II Q Industrial plant (1 hr min) 78.18 / hr
Phone: ( ) / /� I Fax: ( ) Inspections for which no fee is
pj c / J specifically listed (% hr min) 90.00 / hr
CCB Lic.: 2 /b Electrical Lic.0 t - I 27 Suprv. Lic.: 11 5 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: / V h / / //, Subtotal: 7,00 • 7d
iy�� 1 ti Plan review (25% of permit fee):
Print name: R /( /4.,_, , t w145J Date: State surcharge (12% of permit fee): /,2 .09
Authorized signature: TOTAL PERMIT FEE: //A,7 g
This permit application expires if a permit is not obtained within 180
Print name: Date: • days after it has been accepted as complete.
Number of inspections allowed per permit.
1:\ Building \Permits\ELC.PermitApp.doc 07/01/10 440- 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 $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 ,
0 Clock Systems •
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
•
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls '
❑ Outdoor Landscape Lighting*
❑ Protective Signaling •
❑ Other •
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\Building'PermiWELC- PermitApp.doc 07/01/10