Permit CITY OF TIGAR ELECTRICAL PERMIT
1 1 2 ' • COMMUNITY DEVELOPMENT Permit #: ELC2012 00498
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/23/2012
Parcel: 1S 135DCO3100
Jurisdiction: Tigard
Site address: 11545 SW GREENBURG RD
Project: Fitzgerald Subdivision: FIRDALE- UNRECORDED Lot: 2
Project Description: (1) branch circuit add ground rods per PVC Plumbing
Contractor: LITE -RITE ELECTRICAL Owner: FITZGERALD, MEGHAN M & JUSTIN M
28820 SW BURKHALTER RD 11545 SW GREENBURG RD
HILLSBORO, OR 97123 TIGARD, OR 97223
PHONE: 503 - 693 -9775 PHONE:
FAX: 503 - 693 -9775
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 08/23/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/23/2012 $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 Notificati• • Center. Those rules are se/ forth in OAR
952- 001 -0010 through OA 52 -001 -0 90. You may obtain a cop of the rules or direct questions to OUNC by calling 5' 987 o 1.800.3344.
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.
Electrical Permit Application Fo12 OFFICE USE ONLY
71 � .. �� �
City of Tigard
Date/By: 13125 SW Hall Blvd., Tigard, OR 97223 Received r, a-3 Plan Review ,� t � D
Phone: 503.718.2439 Fax: 503.598.1960 DateBy (
Permit No.:
Other Permit: P 4.01,1... �.''t T
T I G A IZ D Inspection Line: 503.639.4175 Date Ready/By: lurk: 1Z1 See Page 2 for
Internet: www.tigard- or.gov Notified/Method: lee Supplemental Information
TYPE OF WORK PLAN REVIEW
El New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /i[ems 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
R I_ and 2- family dwelling El Commercial/industrial El 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 ", "I -3 ",
Job no.: Job site address: '545 (A) �Q� �y IOOHP or more. occupancy. 444,4 I I S VS/ `t' 10 8 . 0 �� J, y 0 Six or more residential units. 0 Recreational vehicle parks.
J h pjJ ❑ ) `^v ❑ Health -care facilities. ❑ Supply voltage for more than
r} -* 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 1 Qty. I Fee. I Total 1 "
New residential single - or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 75,00 2
DESCRIPTION OF WORK A. . (with above sq. ft.)
Limited energy, multi - family 75.00 2
p 1 ► 1 l 11 residential (with above sq. ft.)
• r 1 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
Temporary services or feeders installation, alteration, and/or
City /State /ZIP: 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. Fee for 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 2
Contact name: branch circuit /
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each City /State /ZIP: dwelling, service 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 . Signal circuit(s) or limited- energy •
Business name: L i r i,. / r� panel, alteration, or extension. Page 2 2
L - / . t Each additional inspection over allowable in any of the above
Address: ' 4 / 0 I , 5' / st i Additional inspection (1 hr min) 66.25/ hr •
Ci /State /ZIP �� ����� / ' � /t Investigation (l hr min) 66.25/ hr
ty _ �_'71' ll t / Industrial plant (I hr min) 78.18/ hr
Phone: / ) ��L /./� i Inspections for which no fee is 90.00/ hr ili
specifically listed (A hr min)
CCB Lic..; _ / / •q / Suprv. Lic.: s ELECTRICAL PERMIT FEES A ffiance
Suprv. Electrician sig : ure, tgltired:, � � 111�' o Subtotal:
Plan review (25 /o
/.ter.. / of permit fee):
Print name: / ' " f ,� Date: ` State surcharge (12% of permit fee):
7 /// ' ' TOTAL PERMIT FEE: (pa_ i 3.
Authorized signature:
/, ,, /� , / �,• L This permit application expires if a permit is not obtained ed within 180
'fi // `' ' ' " days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doe 07/01 /10 440 4615T(! 1/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page•2 - Supplemental Information • , • ,
LIMITED ENERGY PERMIT FEES:
RESI.DENTIAL`WORK:ONLY: o •
Fee for all residential systems combined $75.00 •
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
El Garage Door Opener* U i
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
El Other:
COMMERCIALWORK ONL`Y: "`, o �� • ? -j
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
•
❑ Audio and Stereo Systems
❑ Boiler Controls :.
qE
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
❑ 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 •
I.\Building\Permits\ELC- PermitApp.doc 07/01/10