Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00463
T A.RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/06/2012
Parcel: 1 S125DB10000
Jurisdiction: Tigard
Site address: 7198 SW LOLA LN
Project: Nicholas Subdivision: RAZBERRY PATCH, THE Lot: 20
Project Description: (1) install A/C Must be placed within 5' side yard setback and approved rear yard setback
Contractor: ENGELMAN ELECTRIC INC Owner: NICOLAS, SARAH D SEBASTIEN
PO BOX 451 7198 SW LOLA LN
HUBBARD, OR 97032 TIGARD, OR 97223
PHONE: 503-981-8041 PHONE: 650 - 906 -2952
FAX: 503 -981 -4026
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 08/06/2012 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 08/06/2012 $7.42
Type of Use: SF Service or Feeder
Class of Work: OTR 1 ea 12% State Surcharge - 08/06/2012 $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 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 -001-0 90. You ma 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: ��LI C o
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.
08/02/2012 16:32 5039814026 ENGELMAN ELECTRIC PAGE 02/02
Electrical Permit Application RECIVEh I) FOR OFFICE IISC ONLY
City f Ti and Received Permi(N °��aot a —QD .
II n 131 SW Hall Blvd., Tigard. OR 97223 r- i-') 0 2 2012 p t � Review v
m Phone: 503.718.2439 Fax: 503.598.1960 .�+�/� t Date/B : der PC11i, 'I Ex) I Y v •
TI G A R D Inspection Line: 503.639.4175 CITY °F l iV ly{ / " RI See Page 2 for
Internet www.ti and -0r g g ov r V 1 � Supplemental Information
Bill piW.3DI 'S@
• .r:r; • . ..... TYPE'OF WORK.- : ;.;;'.':_ :.
. r °' : , . . .: `PLAN REVIEW
0 New construction ® Addition/alteration/replacement Please chock all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
- - ,, '': = CATEGORY iOE� CONSTRUCTION; : : : . i ':'•
• , exceeds 10,000 amps at 350 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® 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
.. ❑ Emergency system. larger separately derived system.
',IOB SITE' I FO1 MA'^TTON,':AND L'�OCA`I= ION,'" ' `: .. ❑ Addition of new motor load of ❑ "A "E'•, 1.2", "1 ",
Job no.: 25250 I Job site address: 7198 SW Lola Lane 100HP or more. occu pancy
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard OR 97223 ❑ Health facilities. ❑ Supply voltage for more than
ty g ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: l Project name: Wolfer's/Sarah Nicolas ❑ Service or feeder 600 amps or more.
r' . _ ''' FEE SCHEDULE
Cross street/directions to job site: Description I - otv. I Fee 1 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
Es. add'/ 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
.,_,.,
,•: r :fir.... , i (with above it.
��' ' : ..:''� �S'��i - '•. '= �DESCR�TION'OF: WORD �- ,= ,�:`'�. - - � . - . ,. ( �• it) -
Limited energy, multi- family 75.00 2
change out service, wire for a/c residential (with above sq. ft.)
- Services or feeders installation, alteration, and/or relocation
_ 200 amps or less 1 100.70 100.70 2
r' ar . ,5 ' <•; 201 amps to 400 amps 133.56 2
®PItOPERTL'�bOWI!bER >4 � • .r : .'� I `_ .- : _ =� : _ _ > ❑;TENA�U't' ...:..j.
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
Temporary services or feeders installation, alteration, and /or
City /State/ZIP: 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: _ circuits with
feeder fee, 7.42
''.:,-..,.4'-: .. a: I 7.42 2
Fee for
,, . , ,- • .:....., above service o feed ce
.. D APEIGiCA , ^:: �:_ , ar: ; . , :. ' • ❑� CONTAG]" PERSON `' .
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 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
..? :•h = 1 CONTRACTOR F " .:. . , . ... Signal circuit(s) or limited energy
Business name: Engelman Electric Inc panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: P 0 Box 451 Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/ State/ZIP: Hubbard OR 97032 Industrial plant (1 hr min) 78.18/ hr
Phone: (503 ) 981 - 8041 I Fax: (503) 98104026 Inspections for which no fee is 90 / hr
specifically listed (h hr min)
f CB Lic.: 94581 4ectrical ' .: 24 u . Lic.: 4739S : ; ELECTRICAL PERMIT FEES
Subtotal: 108.12
Suprv. Electrician signature, required: 111 Plan review (25%of permit fee):
Print name: Ron Thunderbird Date: 08/02/12 State surcharge (1 2% of permit fee): 12.98
TOTAL PERMIT FEE: 121.10
Authorized signature: ib permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: I Date: • Number of inspections allowed per permit. It 1 Q
I: iBuildin \Et.GPemutApp.doc 07/01/10 440.4615T(11/05/C0M/wEB 'Ol