Permit CITY OF TIGARD ELECTRICAL PERMIT
Permit
$ COMMUNITY DEVELOPMENT #: ELC2012 -00301
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date issued: 05/22/2012
Parcel: 2S103DA07300
Jurisdiction: Tigard
Site address: 10910 SW MIRA CT
Project: Gualpo Subdivision: MIRA PARK Lot: 11
Project Description: Remove & replace 200 amp panel, install ground rods and gas bonded
Contractor: YOUNG ELECTRIC LLC Owner: GUALCO LIVING TRUST
PO BOX 91364 10910 SW MIRA CT
PORTLAND, OR 97291 TIGARD, OR 97223
PHONE: 503 - 706 -9867 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 05/22/2012 $100.70
Specifics: amps or less
12 crt Branch Circuits w /Purchase 05/22/2012 $89.04
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 05/22/2012 $22.77
Electrical
Type of Const:
Occupancy Grp:
Total $212.51
Required Items and Reports (Conditions)
This permit '- ' • - • - •'ect 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 wit = •proved 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 la ree ' you to follow the rules adopted by the Oregon Utility Notification Center. Tho _ ules are set forth in OAR
952 41 1-0010 th , ugh OAR 952 -001 • $ 90. Yo - obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1 .1 = .234
Issu• • By: ' / - � �4 - -. / Permittee Signature:
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 CEIVED FOR OFFICE usi: ()NI.1
CI of Ti and Received • i P ermit No.: 2
�' g 2 Date/fly: J D . Al i 2- 1,cCad�- Iola3a/
13125 SW Hall Blvd., Tigard, OR 97223 i Y �' 2012 Plan Review
. C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I L. A It D Inspection Line: 503.639.4175 Date Ready/By: Lurie: RI See Page 2 for
Internet: www.tigard- or.goV CIT OF TIGAR Notified/Method: Supplemental Information
TYPE OF NAIIIII.DING DIVISION
PLAN REVIEW
❑ New construction N Addition/alteration /replacement Please check all that apply (submit 2 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
al 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 ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: /Q9/O S� �/u Six or or more. occupancy.
❑
T / A ❑Six or more re residential units. Recreational vehicle parks.
City/State/ZIP: "�+�> /[ ? ❑ Health-care za d facilities.
❑ Supply voltage for more than
O ` J ❑ Hazardous locations. 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 Qt.. 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 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
/
Limited energy, multi-family 75.00 2
/0".e '� 6 <Q • ^ d / � dYl/ /f b residential (with ith aboove e sq. q. ft.) Gas r ` Services or feeders installation, alteration, and/or relocation
/ Q/ r 200 amps or less / 100.70 /O 0 2. 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 0 CONTACT PERSON above service or feeder fee, ma �((/
each branch circuit /a 7.42 i]" 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State /ZIP: dwelling, service and/or feeder
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: )1;1 62 6v r /t (C L C c panel, alteration, or extension. Page 2 _ 2
A Each additional inspection over allowable in any of the above
Address: rQ � j /14 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: 7,.' �/ d� Investigation (I hr min) .66.25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: (5 7) 7Qo ,96 7 Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (% hr min)
CCB Lic.:/ . Electrical Lic.: C 5Sy Suprv. Lic.:.'?op3j ELECTRICAL PERMIT FEES ,
ho _ /7/, 766 [ ii //3 Subtotal: /g9
Suprv. Electrician IgnaturC, required: Plan review (25% of permit fee):
Print nameia "y � Date:a V State surcharge (12% of permit fee): t2; • 7 7
TOTAL PERMIT FEE: 5')
Authorized signature: /� d�
This permit application expires if a permit is not ob within 180
Print name: Date: • days after it has been accepted as complete.
Number of inspections allowed per permit.
1:\ Building \Permiu\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:
C OMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
.(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ A udio and Stereo Systems
❑ B oiler Controls
❑ 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
1:\ Building \Permits\ELC- PermitApp.doc 07/01/10