Permit CITY OF TIGARD ELECTRICAL PERMIT
• Per
COMMUNITY DEVELOPMENT
Permit #: ELC2012 -00386
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/27/2012
Parcel: 1 S125DB08600
Jurisdiction: Tigard
Site address: 9496 SW SHADY PL
Project: WORLEY Subdivision: RAZBERRY PATCH, THE Lot: 6
Project Description: (1) branch circuit for residence
Contractor: PORTLAND ELECTRIC CONTRACTORS LLC Owner: WORLEY, RONALD L & KATHERINE E
P.O. BOX 1422 9496 SW SHADY PL
SANDY, OR 97055 TIGARD, OR 97223
PHONE: 503 - 501 -9064 PHONE: 503 -452 -1890
FAX: 503 - 668 -1999
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 06/27/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/27/2012 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OA 2 -001- 090. 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:
•
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.
Electricals Permit Application REC.EIVE.
Received (e . � I a � C/01 i�
City of Tigard Date/By:. ? / y Permit No. J
° 13125 SW Hall Blvd., Tigard, OR 97223 ) U N 22 7 2012 Plan Review �0. 004 ' C Phone: 503.718.2439 .Fax: 503.598.1960 Date/By: • Other Pemut: c�
T I G A R D Inspection Line: 503.639.4175 I G' � T ate Read : • Ju wi See Pa e 2 for . OF Internet: www.tigard -or.goV otifie d / Method: B r Supplemental Information '
TYPE OF WOR 1J PLAN REVIEW
. ❑ New constriction 0 Addition/alteration/replacement Please check all that apply (submit 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
el- 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 ", "l -2 ", "l -3 ",
Job no.: Job site address: 94/1 r l< Six orm rmore. occupancy.
�� �A'Y �� D . ❑Six or more residential units. ❑ Recreational vehicle parks.
• / �+ ❑ Health -care facilities. ❑ Supply voltage for more than
City /State /ZIP:
�/ A a7)I ,9 • ' 7Z Z' ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: l.,t /B , L - $(,/ ❑ Service or feeder 600 amps or more.
6�Y FEE SCHEDULE
Cross street/directions to job site: Dneription I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
•
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add' 1 500 sq. ft. or portion 33.92 I
Tax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK !(with above Sq. -ft.) .
• Limited energy, multi- family 75.00 2
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
Name: 401 amps to 600 amps 200.34 2
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: ( ) I 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. Feefor branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON ' above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
• service or feeder fee, first / 56.18 /_ )8 , 2 '
Contact name: .
branch circuit
Each add'l branch circuit 7.42 ' 2
Address: Miscellaneous (service or feeder not included)
Ci /State /ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
•
Phone: ( ) I 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
g
Business name: pen �'LA E / Fer ' t / panel, alteration or extension. Paget 2
a -•-(- •¢R-p» Each additional inspection over allowable in any of the above
Address: _ /7 .5.yv W 1 ,0 � ' y; Additional inspection (I hr min) ' 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State /ZIP: �! /� y vv'
D Il . t7 • % ( Industrial plant (I hr min) 78.18/ hr
Phone: . per 07 Fax: ( ) Inspections for which no fee is 90.00/ hr
specifically listed (%: hr min)
•
CCB Lic.V , E ectrical Lic:: -_ Suprv. Lic.: - , ELECTRICAL PERMIT FEES
Suprv. Electricity ' - : cure, required:� l u' o Subtotal: •
` / , , r. Plan review (25% o f permit fee): •
Print name: 2z Date:,/ ....27../ State surcharge (12% of permit fee): 'G,
^�/ G � TOTAL PERMIT FEE: /, z,
�r��c
Authorized slgnature:d This permit application expires if a permit is not obtaineed within 180 • 7 � days after it has been accepted as complete:
Print name: Date: • Number of inspections allowed per permit. •
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 - - - 440- 4615T(I1/05 /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*
El Burglar Alarm
El Garage Door Opener*
` 1 I 1
❑ 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
El Boiler Controls
El Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ ,Instrumentation
❑ Inter Paging Systems
❑ Landscape.Ir-rigation Control*
❑ .Medical
❑ Nurse Calls •
•
El .Outdoor Landscape Lighting* • .
El Protective Signaling .
❑ Other -
Total number of commercial systems: •
*No licenses are required: Licenses are required
for all 'other installations .
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