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Permit CITY OF TIGARD ELECTRICAL PERMIT • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00695 T [ C; A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/11/2012 Parcel: 25111 BA01700 Jurisdiction: Tigard Site address: 14325 SW 97TH AVE Project: Mitchell Subdivision:CONDO SUPPLEMENTAL PLAT NO.3: Lot: 32 Project Description: (1) branch circuit to mount disconnect and whip to heat pump. Contractor: PLUGS & SWITCHES Owner: MITCHELL, PATICIA PO BOX 111 14325 SW 97TH AVE SHERWOOD, OR 97140 TIGARD, OR 97224 PHONE: 503 - 620 -3203 HONE: 503 - 969 -4613 FAX: FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 12/11/2012 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 12/11/2012 $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 pe is issued subje • the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law. All work will be d• e in accordance with ap• • plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 day'. ATTENTION: Oregon It req you to follow the rules adopted by the Oregon Utility Notification �? i e e rio re set forth in OAR 95 -001 -0010 t rough OAR 9 -001 0' • c • may obtain a cosy of the rules or direct questions to OUNC by calling 51, 1. r // / a r /d 4 ssued By: ` Permittee Signature: 1, 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: O T'. ��' INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' • �� f„;.16F 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 rr �� FOR OFFICE USE ONLY City of Tigard Date/13 /34 Permit No.: e - d0(v/`- • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review m Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Per 1 it : I i :� It l) Inspection Line: 503.639.4175 Date Ready/By: Sufis: ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW Please check all that apply (submit 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 Q 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 ", ,{ q 4,4: 1 OOHP or more. occupancy. Job no.: Job site address: 43 c�S J L() `7 7n4 ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: G - 'a.4 0 7 � ❑ Health-care facilities. ❑ Supply voltage for more than J 1 ❑Haza rdour 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: lam. - Tao A i Atib 70 Scw 97 f r 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 DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi- family 75.00 2 ,, 0 t 'o � t- A-AA) W p residential (with above sq. ft.) ry ' C�.I Services or feeders installation, alteration, and/or relocation 17) H` - Po Wt-P 200 amps or less 100.70 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 401 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 City/State /ZIP: Temporary services or feeders installation, alteration, and /or 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: A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name - r -►-.� B. Fee for branch circuits without W 1 / service or feeder fee, first 56.18 5r/ p. - a 2 Contact name: branch circuit Each add'l branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) Each manufactured or modular City/State /ZIP: dwelling, service and/or feeder 67.84 2 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: panel, alteration, or extension. Page 2 2 s a w ) ` r � t-t / G • Each additional inspection over allowable in any of the above Address: p • O .).4 I t t Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: � 1� Investigation (1 hr min) 66.25/ hr 5 H VJ� © '7 / TZ/ Industrial plant (1 hr min) 78.18/ hr Phone: (5) Cdr (� 1 3 Fax: (! j y ) R�S _ t � Inspections for which no fee is 90 / hr Ib fn 7 /t,t specifically listed (V: hr min) CCB Lic.: I l- F1JSl- tJ Electrical Lic.:. _S_ r j Suprv. Lic.: 5D i 75 ELECTRICAL PERMIT FEES � Wtt t 3 Subtotal: 56 • / g Suprv. Electrician signature, required: -, Plan review (25% of permit fee): r Print name: DO /' Jr l . • Date: l a ) I ._ 1 4_ State surcharge (12% of permit fee): to • 7t/ TOTAL PERMIT FEE: (0 A . 7 `- Authorized signature: This permit application expires if a permit is not obtained within 180 Print name: Date: * days after it has been accepted as complete. Number of inspections allowed per permit. I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(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: El Audio and Stereo Systems* ❑ Burglar Alarm El Garage Door Opener* • El Heating, Ventilation and Air Conditioning System* El Vacuum Systems* El Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: El Audio and Stereo Systems El Boiler Controls El Clock Systems El Data Telecommunication Installation El Fire Alarm Installation El HVAC El Instrumentation El Intercom and Paging Systems El Landscape Irrigation Control* n Medical El 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 1 \Buildmg\Permus\ELC- PermitApp doc 07/01/10