Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00391
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/28/2012
T (G ;1.EtD 9 Parcel: 2S112CC04000
Jurisdiction: Tigard
Site address: 15765 SW 80TH AVE
Project: Shaefer Subdivision: BURNHAM TRACT Lot: PTS 68-
Project Description: Wire for NC & outlet
Contractor: ENGELMAN ELECTRIC INC Owner: SCHAEFER, SHERYL M
PO BOX 451 15765 SW 80TH AVE
HUBBARD, OR 97032 TIGARD, OR 97224
PHONE: 503 - 981 -8041 PHONE: 503 - 230 -5969
FAX: 503 -981 -4026
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 06/28/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/28/2012 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 9 2- 001 -0090. You m LFI�i may obtain
U
taiinn a copy of the rules or direct questions to OUNC by calling 503 or 1.800.332.2344. t
Issued By: Ji_ Permittee Signature: u PPR' ' IQ'"
OWNER INSTALLATION ONLY
The installation is being made on properly 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.
06/27/2012 11:50 5039814026 ENGELMAN ELECTRIC PAGE 02/02
Electrical Permit ApplicationRECEIVED FOR OFFICE USF ONLY
City of Tigard Received le
Date/13 : 60 Sr Permit No.0,e, a , _ co Nss ..,
1.11, . 13125 SW Hall Blvd., Tigard, OR 9n23JUN 2 7 2012 Plan Review
2 • Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit re,-;474 "1
Inspection Line: 503.639.4175 'r' e, 8 See Page 2 for
T I GA RD Inspection Date Ready/By: f
OF TIGARD Notified/Method: Supplemental Information
Internet: www.tig,ard-or.gov
, Bumplive DIN/1.51011
, . ... .!::,....., . , ..,...i.. tait ;;:;, 1: .:. :: `,.-:, . • -,:,. . ' ' :.. . : : ' '..' -:: ' • ' . :' .P;AN REVIEW •
Please cheek all that apply (submit 2 sets of plans w/items checked below):
El New construction Addition/alteration/replacement
0 Service or feeder 400 amps or more 0 Building over three stones.
0 Demolition Other: where the available fault current 0 Marinas and boatyards.
CATEGORY tONSiRt ':!: 7'..:: : -: ;::.. '''.:: exceeds 10,000 amps at 150 volts or [)Floatin buildings.
.1 less to ground, or exceeds 14.000 0 Commercial-use agricultural
1 - and 2-family dwelling ID Commercial/industrial 0 Accessory building buildings.
Multi-family 0 Master builder 0 Other: 0 tonne for all other installations.
Fire pump.
0 Installation of 75 KVA or
DEmergency system.
.,.. . .
.ros SITE INFORMATION AND LOCATION li .. .:L.: ":-:::.-.-•;. . •
0 Addition of new motor load of 0 larger separately derived system. V. •
Job no.:Xlyy) Job site address:15'7 t q 9 g,o Ayr 100HP or more. occupancy.
. 0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP:
0 Health-care facilities. 0 Supply voltage for more than
C it .' 8(1M
CI Hazardnus locations. 600 volts nominal.
Suite/bldg./apt. no.: Project na?" 0 A . m 1 . ,0 1 0 . 1if i l
A 0 Service or feeder 600 amps or more.
SCHEDULE
Cross street/directions to job site:
Description I QtY• I Fee. I That I •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 168.54 4
,_ , / i Ea. addl 500 sq. ft. or portion 33.92 I
Tax map/parcel no.. . dok '0 1 g CC _ OLIrg...) Limited energy, residential
75.00 2
. ' ' " . II)30§C7RAIIIIPI OF WORK :: •....f.... !.....::. ::.:;..,::"...... :•171; (with above sq. ft.)
Limited energy, multi-family
1A)I SeQ ( /CJ f a)l-itiP residential (with above sq. ft.) 75.00 2
Services or feeders Installation, alteration, and/or relocation
200 amps or less 100.70 2
la• PROPERTY oivNgii... ;:-.-....: ,.!.',. t; : 1.. .-.::;,-. alEN.Al■ : - :.,-,•,-. r 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
Temporary services or feeders installation, alteration, and/or
City/State/ZIP:
relocation
Phone: ( ) I Fax: ( ) 200 anms or less 59.36
. i
Owner installation: This installation is being made on property that I own which is not - 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps _ 16834 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
• . 0 AA:tit :: , :i 0 CONTACT PERSON .!:,: .: -.'. above service or feeder fee,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit i 56.18 ci i g 2
Each addl branch circuit I 7.42 7,'-ft 2
Address:
Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP:
dwelling, service and/or feeder 67.84 2
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:',.• -, .--...-,,- qt !,, • ,::' .. ,'----.' ' ,• ,. - .';. Signal circuit(s) or limited-energy
Business name: . g - Irmo E)e,(4-rit. TYIC.• . panel, alteration, or extension. _ Page 2 ,
Each additional inspection over allowable in any of the above 2
Address: f) c.) ' 0 l—I • Additional inspection (I hr min) 66.25/ hr
(
ti) Itib Oe> qr7O - Investigation (1 hr min)
66.25/ hr
Industrial plant (I hr min)
78.18/ hr
Phone: An • .1- TIL ' Fax: ril r • '4
t . • . - ....., Inspections for which no fee is
90 00/ hr
--- _ - --- specifically listed (A hr min)
CC: : Lic.: ari Vika] i .: ( 2 ,-,irignatEld -. ....., :,.: -
. . ELECTRIC.AL PERMIT FEES
k-
Suprv. Elect!' ' signature, required. Millr r _ w .. 7 . Subtotal
(p6
• A
2n
A .. r Date: / _ __
AA A 1 " --I
1 —■ _ Plan review (25% of permit fee):
Print name:
State surcharge (12% of permit fee): 7 V
TOTAL PERMIT FEE:
Au — 7 I . Q
Authorized signature: ' This permit application expires if a permit is not obtained within 1
days after it has been accepted as complete.
Print name: I Date:
• Number of inspections allowed per permit.
i I . 33 v"
IABuildineerrolts\ELC-PermilApp.dsx 07/01/10 440