Permit CITY OF TIGARD ELECTRICAL PERMIT
11 2 • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00572
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/02/2012
Parcel: 1 S 136DCO2701
Jurisdiction: Tigard
Site address: 7040 SW BAYLOR ST
Project: Flores Subdivision: ELNOLA HEIGHTS Lot: 2
Project Description: Electrical permit for work done by new owner, Flores. Alteration of (3) branch circuits.
Contractor: OWNER Owner: FLORES, PABLO
7040 SW BAYLOR ST
TIGARD, OR 97223
PHONE: PHONE: 503 - 260 -5644
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 10/02/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/02/2012 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 ' • - r • r• - : 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. • TTENTION: Oreg• law • • ires you to follow the rules adopted by the Oregon Utility Notificatio en er. Those rules are s t forth in OAR
952 -1 r 1 -0010 through OAR 95 1/1-00; r. may obtain a copy of the rules or direct questions to OUNC by calling 50 . 32.1987 0 .: • 0.3 .
4 / t
Issued B� Permittee Signature: �� . 6
OWNER INSTALLATION ONLY
The installation is being made on ro• - ' •wn which> not int sale, lease or rent.
OWNER'S SIGNATURE .1o %� ,. ... Date: / -2— V - - -
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 FOR OFFICE USE ONLY ,�/�
III City of Tigard Received / Z I permit No.: �4Q��- FJt/��
Date/By: [
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
1' I G A R O Inspection Line: 503.639.4175 Date Ready/By: lurk: IB See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ❑ Addition/alteration/replacement
❑ 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
❑ 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 ", "1 -2 ", "1 -3 ",
Job no.: Job site address: /) � 1001 or more. occupancy.
✓ LfQ C/ B E�2jr "5 5 ❑ Six or more residential units. ❑ Recreational vehicle parks.
Ci /State /ZIP: / ❑ Health -care facilities. ❑ Supply voltage for more than
ty `T ) r 0� 97 2_ ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: l -a2f S ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
J Description I Qty. I Fee. I Total
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
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: 044 f/ $ 401 amps to 600 amps 200.34 2
/� 601 amps to 1,000 amps 301.04 2
Address: 7//' �
I. �, Over 1,000 amps or volts 552.26 2
0(: , r � r ^ .�� .t � Te services or feeders installation, alteration, and /or
City/State /ZIP: j 4 `, 7-2- ° relocation
Phone: (sc3) // �/ si v q 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 excpange�c ording to ORS 447, 449, 670, an 70 L -
�� / Branch circuits — new, alteration, or extension, per panel on. Owner signature:
Date: `! �+� / r A. Fee for branch circuits with
❑ • ' PLICANT ❑ CONTACT P RSON above service or feeder fee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit ► 56.18 2
Each add'l branch circuit 1 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: ` , p panel, alteration, or extension. Page 2 _ 2
ry Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State /ZIP: Industrial plant (I hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (%z hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEE S
Suprv. Electrician signature, required: Subtotal: 7/, at Z
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): q..6
TOTAL PERMIT FEE: - 71. sy
Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
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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:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n 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
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