Permit CITY OF TIGARD ELECTRICAL PERMIT
1114 t3 . COMMUNITY DEVELOPMENT • Permit #: ELC2012 -00231
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/24/2012
Parcel: 1 S136CB08400
Jurisdiction: Tigard
Site address: 10980 SW 81ST AVE
Project: Reibson Subdivision: HERB AND PEGGIE'S PLACE Lot: 30
Project Description: Replace panel, new circuit for hot tub.
Contractor: FUZION ELECTRIC LLC Owner: REIBSON, MARK D & KITTIE J
21782 SW KRISTIN CT 10980 SW 81ST AVE
ALOHA, OR 97006 TIGARD, OR 97223
PHONE: 503 - 528 -6033 PHONE:
FAX: 866 - 284 -0482
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 04/24/2012 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 04 /24/2012 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 04/24/2012 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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 wo 1 is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. • a rules are set forth in OAR
952- 001 -0010 throe / g A � \ IIAR� \ 5 2- 001 Qp80. You may obtain a copy of the rules or direct questions to OUNC by calling 50.. 3 '87 or : r r3 .2344.
Issued By: ` �! „O Permittee Signature: b %i`IL.d
OWNER INSTALLATION ONLY
if
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
i N ' ' ' CTOR INSTALLATION ONLY
1r
SIGNATURE OF SUPR. ELEC' 3 ' 1tr Date:
LICENSE NO. (� •
Call 503'. 39.4175 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 with 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 7 1 ED e Dceid R e By ve y 4/ 42%, Permit No.: L xe,te 2 s!
1 13125 SW Hall Blvd., Tigard OR 97 Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.598.9 Date/By:
f l c. n It D Inspection Line: 503.639.4175 APR 2 4 2 012 Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF W° 81TY OF TIGAF D PLAN REVIEW
❑ New construction ,iAddition/alterE W Ner 1 i SIQ'N 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
rig_- 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: X 560 / �` 5 L 1 more. occupancy.
q ^7 v ❑ Six ix or or more more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: f tC c c 1 / 2.2 3 ❑ Health -care facilities. ❑ Supply voltage for more than
J / ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: /nark � E./zoo/0 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 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'l 500 s ft. or portion 33.92 1
Tax map /parcel no.: Limited ener residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
^epl0. e / n e _� ( . j f � I �� Limisidetial(muabfvesy 75.00 2
61,1 ' l residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less , 100.70 to _7C) 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
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 7 L 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each City/State /ZIP: dwel service�and/or feeder 67.84 2
Phone: ( ) 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
Business name: �7� Erec c / panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 24 , - / -f___ S- 4,--- c h h- , Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: h �r � Investigation (I hr mm) 66.25/ hr
w 7C/ �' Industrial plant (1 hr min) 78.18/ hr
Phone: ( 9 )y ) 5yg 6,0 3 '3 Fax: ( ) Inspections for which no fee is 90.00/ hr
specifically listed (V2 hr min)
CCB Lic.: / gr97/8- - Electrical Lic.: CSq / Suprv. Lic.: 52' 5 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: `— o Subtotal: ) p $ , 1
Plan review (25 /o of permit fee):
Print name: Z�' i1 tit it Date: L�/_� / State surcharge (12% of permit fee): i ',�• 97
/ / / TOTAL PERMIT FEE: /,Zi d q
Authorized signature: 4 of This permit application expires if a permit is not obtained within 180
Print name: E - e, �! / , it has been accepted as complete.
F• It IA b' -(/r\ Date: 7 /� Number of inspections days after allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440-461ST(lI /0S /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:
El Audio and Stereo Systems*
El Burglar Alarm
El Garage Door Opener*
El Heating, Ventilation and Air Conditioning System* •
El Vacuum Systems*
El Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
. ❑ HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
•
for all other installations
1: \ Building \Permits\ELC- PermitApp.doc 07/01/10