Permit r, CITY OF TIGARD ELECTRICAL PERMIT
III ! c COMMUNITY DEVELOPMENT Permit #: ELC2012 -00690
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/10/2012
Parcel: 1 S136DD03800
Jurisdiction: Tigard
Site address: 11675 SW 66TH AVE
Project: City County Insurance Services Subdivision: WEST PORTLAND HEIGHTS Lot: 4 -8 & 27
Project Description: TI. Move one wall.
Contractor: KEC ELECTRIC INC Owner: CITY COUNTY INSURANCE SERVICES
761 SW BAILEY AVE 1212 COURT ST NE
HILLSBORO, OR 97123 SALEM, OR 97301
PHONE: 503 - 439 -0904 PHONE:
FAX: 503 - 640 -3838
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 12/10/2012 $71.02
Specifics: Service or Feeder
1 ea Signal circuit or Limited 12/10/2012 $75.00
Type of Use: SF Energy Panel
Class of Work: ALT 1 ea 12% State Surcharge - 12/10/2012 $17.52
Electrical
Type of Const:
Occupancy Grp:
Total $163.54
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 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 enter. Those les are set forth in OAR
952- 001 -0010 through 0 52- - 90 You may obtain a copy of the rules or direct questions to OUNC by calling • ' ' ' ' .1987 or 1.8 .2344.
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 Cl Application FOR OFFICI: USE ONLY
R�CEI�IED Received ��� AM. of Tigard
b Date/By: /e ;v 4.2... •� ' 'errnit No. CSC, a(/�a OO(O /�
1111 q 13125 SW Hall Blvd., Tigard, OR 97223 nn 0 2 012 P lan R eview
Phone: 503.718.2439 Fax: 503.598.196W E C 1 Other Permit:
Date/By:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: 65 See Page 2 for
Internet: www.tigard - or.gov CITY OFTIGARD Notified/Method: 776— Supplemental Information
Tyr OF WUIDIN i DIVISION PLAN REVIEW
❑ New construction , LEI, J/ A dddttion/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.
CATEG OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
El 1- and 2- family dwelling ommercial/industrial ❑ Accessory build 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 ", "l -2 ", "l -3 ",
Job no.:a /oF ( Job - 3ite address: /4 ? $ G `7-j ✓ I00HP or more. occupancy.
/[ 0 or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: / p. ,, ,- ❑ Health -care facilities. ❑ Supply voltage for more than
�,5 / O ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: C C 1, ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 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
(6c t'r ftN4.)1 A cry p49 residential (with above sq. ft.) 75.00 2
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
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
ty relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
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: B. Fee for branch circuits without i
service or feeder fee, first I 56.18 Sly
Contact name: branch circuit
Each add'I branch circuit • 2 7.42 +L 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 67.84 2
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- ener»t •
Business name: /� ce 'rt C .,u
•
panel, alteration, or extension. ¢ Page 2 2
b Each additional inspection over allowable in any of the above
Address: )Ir ( S(.• /S4 r (L,, /J� A Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: li- ,C( fo Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed (%2 hr min) 90.00 / hr
4
CB Lic.: 5 Ix 7 Electrical Lic.: [ Suprv. Lic.: ' 75 5 ELECTRICAL PERMIT FEES
Subtotal:
/a /L3 //
Suprv. Electrician sig atu r quired: - y /O///3
Plan review (25% of permit fee):
Print name: /4 Na � pc, . 07 Date: 7 , z . 4� / State surcharge (12% of permit fee):
� '`D / TOTAL PERMIT FEE: A5 , S
Authorized signature:
This permit application expires if a permit is not obtained within 1 0
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
I:\ Building \ Permits\ELC- PermitApp.doc 07/01/10 440-4615T(1 I /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
❑ Clock Systems
ata Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
p 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