Permit CITY OF TIGARD ELECTRICAL PERMIT
1111 g ' C OMMUNITY DEVELOPMENT P ermit #: ELC2012 -00566
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/01/2012
Parcel: 1 S125DCO2900
Jurisdiction: Tigard
Site address: 7160 SW VENTURA DR
Project: Johnston Subdivision: WASHINGTON SQUARE ESTATES Lot: 22
Project Description: (2) branch circuits for bedroom remodel.
Contractor: SAM HARDING INC Owner: JOHNSTON, MICHAEL R & MARY ELLEN
23833 NE GLISAN 7160 SW VENTURA DR
WOOD VILLAGE, OR 97060 TIGARD, OR 97223
PHONE: 503 - 492 -3697 PHONE:
FAX: 503 - 492 -3978
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 10/01/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/01/2012 $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 subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law, All work will
be don in accordance it, 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 -w ire you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 01- 0010th ough OAR 952 -r •1 -009• You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344
I sued By: Permittee Signature: ■-■111■
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' / / k 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
City of Tigard Dale/Bee /O/ i2 EGGv`'/c9' '°
Permit No.:
• 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
' C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for
T I G A R D N otified/Method: Supplemental www.tigard or.gov PP lemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ddition/alteration/replacement Please check all that apply (submit 2 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
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 ", "I -2 ", "1 -3 ",
�7 IOOHP or more. occupancy.
Job no.: Job site address:
//O �/ ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: '/ � A /L � / D� 9 7 ❑ Health-care ion ❑ Supply voltage for more than
/ ❑Haza rdzaour locations. cat 600 volts nominal.
Suite /bldg. /apt. no.: Project name: rja „/f/5 mot/ ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
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
#'tED/toa , 7 A ,4 i7u 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
•• l�/'�►57 t7I V ELI? / l�f/L 601 amps to 1,000 amps 301.04 2
Address: — 7/4C' , ( ./ TZJ�d Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
y '774, z/eD / e � , 9 7 2_23 relocation
Phone: ( f-5-z - g95S 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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: s.Q��R2� d .,l At B. Fee for branch circuits without
/ p service or feeder fee, first 56.18 / 2
Contact name: -Too �� �-a,,, F, branch circuit
Each add'I branch circuit 7.42 / 2
Address: 2.3833 Ale uS Miscellaneous (service or feeder not included)
City /State /ZIP: tie Each manufactured or modular 67.84 2
w�7L Ve ��e i , v/? _ 07rxt, dwelling, service and/or feeder
Phone: () 79 _G Fax: : (Spy) *92 - 39A5 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: 5E.4 -!n , 1T.a" , 77e3/?- eve Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: S,Q,t,. 144,e z)//1/4„4.7 ikiC panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 2 ,Zt3 3 � iym ., Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City /State /ZIP: �
c.,..),902:, (// c_4 4r ,. oar. 9 .,..xtr., Industrial plant (1 hr min) 78.18/ hr
Phone: ( .5) zeo ..G f 65.03) 4 3978 Inspections for which no fee is 90.00 / hr
specifically listed (%2 hr min)
CCB Lic.: er g Electrical Lie.: j .5,L9 c Suprv. Lic.: 5 7 7_7...s ELECTRICAL PERMIT FEES
/. n � JL � ! � t / ' r/ t 4i Subtotal: or . coo
Suprv. Electrician na ur `
required: �GCL/ �/ ` /o//
Plan review (25% of permit fee):
Print name: 7 -0.bJ p //'7 a „.„ Date: /U - / a_ State surcharge (12% of permit fee): 7. co )
��� a TOTAL PERMIT FEE: `7/ . 3
Authorized signature: �.�� 220/ �' � �� ,
�/Y (A This permit application expires if a permit is not obtained within 180
Print name: �h /J / ) . /�R�D / ".J� b a t e: / — / — f Z i days after it has been accepted as complete.
✓`� Number o inspections allowed per permit.
I: \Building\Permits\ELC- PermitApp.doc 07/01/10 4404615T(11/05/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*
❑ 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
n Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ 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
1: \Building\Permits\ELC- PermitApp doc 07/01/10