Permit n CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00194
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/05/2012
Parcel: 2S112BA04600
Jurisdiction: Tigard
Site address: 14295 SW 80TH PL
Project: Weaver Subdivision: WAVERLY MEADOWS Lot: 9
Project Description: (7) branch circuits for kitchen remodel.
Contractor: PHASE FOUR LLC Owner: KROPP, BEVERLY &
PO BOX 5034 WEAVER, RIC
SALEM, OR 97304 14295 SW 80TH PL
TIGARD, OR 97224 •
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PHONE: 503 - 930 -4890 PHONE:
FAX:
FEES
Quantity Description Date Amount
7 crt Branch Circuits wo /Purchase 04 /05/2012 $100.70
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/05/2012 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
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Total $112.78
Required Items and Reports (Conditions)
This permit ' ssued s to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don in accordance with : •prove• •fans. 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 equi -s ou to follow the rules adopted by the Oregon Utility Notification Center. Those • s re set forth in OAR
95 01 -0010 through OAR 952 - 1 -0090. Y. ay obtain a copy of the rules or direct questions to OUNC by calling 50 • 1.800 2344
sued By: ��I � Permittee Signature: i
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:
TRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' A Date:
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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 Foiz 0FFICI.: USE ONLY
City of Tigard DECEIVED Date /B 5 /0... / Permit No.: E c /J2-31 9f
u 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
C . Phone: 503.718.2439 Fax: 503.598.19 60 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 APR 5 2012 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
OF TIGARD
TYPE OF PLAN REVIEW
❑ B M I p G DIVISION Please check all that apply (submit 2 sets of plans w /items checked below):
New construction ddition/a era Io re acemen
❑ 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
D'1and 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: / s e e- r` 100HP or more. occupancy.
1�L ❑Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 7 — ) ei U ❑ Health - care facilities. ❑ Supply voltage for more than
J ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: 1 FEE SCHEDULE
J LI'e�./L Or , 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'l 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
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Limited energy, multi- family 75.00 2
� l
1 C 1 t ( ` — r 2 —" - D /AAA Lti. e ILO G ruil t- residential (with above sq. ft.) _
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
401 amps to 600 amps 200.34 2
Name: Gt.)
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
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: ePt/k,9,5,�17-- B. Fee for branch circuits without
service or feeder fee, first
/ 56.18 $lp. ' 2
Contact name: 74 1 c .L p.-0 1z branch circuit
Each add'I branch circuit 6 7.42 vi/I . S 2
Address: Pa • Box S-O 3 Y Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State /ZIP: S ,l„ b1-. 7 7 30 N dwelling, service and/or feeder 67.84 2
Phone: (S63) 9 3 D . ysio Fax :: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Pii 9 S ,e14, C e IA-, SJ. , C01.� Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: -9." • ° 41 C panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 5 fir,, _..e— Additional inspection (1 hr min) 66.25/ hr
Investigation (t hr min) 66.25/ hr
City/State /ZIP: Industrial plant (1 hr min) 78.18 / hr
Phone: ( ) n-,3 / Fax: ( Inspections for which no fee is
2 / x �// specifically listed (V2 hr min) 90.00 / hr
CCB Lie.: /96 Electrical Lic.: _7C/ 9J L Suprv. Lic.: G/7 Z ELECTRICAL PERMIT FEES
` 0 i/2 Subtotal: /o e , 70
Suprv. Electrician signature, required: Plan review (25% of permit fee): 1 ----
Print name: 24 c_ 1—D / Date: y_ s -/ Z State surcharge (12% of permit fee): l,9_0?
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.
N um be r of inspections allowed per permit.
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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*
El Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
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❑ Vacuum Systems*
El Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
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(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
E l Nurse Calls '
El Outdoor Landscape Lighting*
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❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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