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Permit
CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2012 -00717 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/17/2012 Parcel: 25111 CC20600 Jurisdiction: Tigard Site address: 15640 SW GREENLEAF CT Project: Primrose Subdivision: SUMMERFIELD NO.5 Lot: 263 Project Description: (1) 200 amps or less for panel change Contractor: OWNER Owner: PRIMROSE, ROBERT & JANIS 15640 SW GREENLEAF CT TIGARD, OR 97224 PHONE: PHONE: 503 - 646 -1893 FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 12/17/2012 $100.70 Specifics: amps or less 1 ea 12% State Surcharge - 12/17/2012 $12.08 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 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 Center. Those rules are set forth in OAR 952- 001 -0010 through OA 52 -001- 90. You m obtain a copy of the rules or direct questions to OUNC by calling 503� or 1.800.332.2344. 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 503.839.4175 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 �1 City of Tigard RE CEiVbf eii3y: � a (I� � C `' ( Permit No.: � (7 / Ot ! / IN • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 7 Phone: 503.718.2439 Fax: 503.598.1960 DEC 17 2012 Date/By: Other Permit: Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for I I c, A R U Notified/Method: l r ( &' Supplemental Information Internet: www.tigard- or.gov CITY OFTIGARp TYPE OF WORRUILDING QIUiSlopd PLAN REVIEW Please check all that apply (submit 2 sets of plans w /items checked below): ❑ New construction , Addition /alteration/replacemeent ❑ 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 X 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 ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ", r �[ lOOHP or more. occupancy. Job no.: Job site address: /,; b yo ar�Ph�al` �i/ ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: ¢ ri e p O i g 9. 7,201. oZ O'� 1i V ❑ Health -care facilities. ❑ Supply voltage for more than �• ❑ 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: �a �...4,740 y, [ .42 �& r✓ #,, Description j Qty. I Fee. I Total I " 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 2 144,'7 / .. Da.� -e- 01 ©0 � residential residential (with above sq. ft.) may` � Services or feeders installation, alteration, and/or relocation 200 amps or less / 100.70 2 Ar PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: A b. ,„7--- i JY! r0 S Ja_ 601 amps to 1,000 amps 301.04 2 Address: /5'6 q a ,,e L° n xe.,..e.c et/. Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and /or City/State /ZIP: Q h Z ' ©4 77a �y cZ.j' relocation Phone: (5 o3) 4,z/ — g 9 3 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, 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: A2 --/7—)2—._. 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 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) City/State/ZIP: Each manufactured or modular 67.84 2 ty 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: panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address:re--01..CZ,‘1 Additional inspection (1 hr min) 66.25/ hr Investigation (1 hr min) 66.25/ hr City /State /ZIP: Industrial plant (1 hr min) 78.18 / hr Phone: ( ) Fax: ( ) Inspections for which no fee is specifically listed (%S hr min) 90.00 / hr CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES Subtotal: Suprv. Electrician signature, required: Plan review (25% of permit fee): Print name: /o . 4O e n P hine ssx Date: t A./7_ s State surcharge (12% of permit fee): TOTAL PERMIT FEE: /1 3' s 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. 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: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* El 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 El Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation El HVAC ❑ Instrumentation El Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical El Nurse Calls ❑ Outdoor Landscape Lighting* El 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