Permit , ' OF TIGARD ELECTRICAL PERMIT
' . C COMMUNITY DEVELOPMENT Permit #: ELC2013 -00012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/08/2013
Parcel: 1S134CB03600
Jurisdiction: Tigard
- Site address: 12480 SW SUMMER CREST DR
Project: Betton Subdivision: SUMMER HILLS PARK Lot: 34
Project Description: (1) 200 amp service and (1) branch circuit for temporary kitchen downstairs during kitchen remodel project.
Contractor: OWNER Owner: BETTON, KAY L
GRILLEY, SHARON
12480 SW SUMER CREST DR
TIGARD, OR 97223
PHONE: PHONE: 503 - 704 -0181
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 01/08/2013 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 01/08/2013 $7.42 .
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Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 01/08/2013 $12.97 •
Electrical
Type of Const:
Occupancy Grp: ..
l
Total $121.09
Required Items and Reports (Conditions)
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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 0 52- 9 . ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on prop rty I own which is not i tended for sale, lease or rent. ^�
OWNER'S SIGNATURE 4 Date: ig l 2� J
,/ CONTRACTOR INSTALLATION ONLY
J` 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 Applic/ n FOR OFFICE us ONLY
Cl of Ti and 1 l .�� Received �G permitNo.n ��n
. ` J g DateBy/ 4 a i o5r/ /3 �9QI�
al 13125 SW Hall Blvd., Tigard, OR 97 A Plan Re ew
III C Phone: 503.718.2439 Fax: 503.5,� 8 2013 Date./By: Other Permit:
f I G n R D Inspection Line: 503.639.4175 Date Ready/By: Sufis: El See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: 776-"" Supplemental Information
TYPEJL'MW DIVISIUr 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
di l- 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 ", "l -3 ",
Job no.: I Job site address: Aa 1 11--,0 sa , yA/F� 100HP or more. occupancy.
❑
❑Six or more residential units. Recreational vehicle parks.
City/State/ZIP: f Health -care facilities. ❑ Supply voltage for more than
C 2��7 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: Description I Qty. I Fee. I Total I •
AA New residential single- or multi - family dwelling unit.
1, I .f e v Includes attached garage. .
Y
Subdivision: Lot no 1,000 sq. ft. or less 168.54 4
1 l� Ea. add'I 500 sq. ft. or portion 33.92 I
Tax map/parcel no.: S " Limited energy, residential 75.00 2
DESCRIPTION OF WORK • (with above sq. ft.)
Limited energy, multi - family
01 l 75. 4.4 of s+4. (ii 70 D n d , 62 75.00 2 residential (with above sq. fl.) -
, _ 'TI 0 �� ,! a, ( / � / �� � 200 Services or feeders installation, alteration, and/or relocation
1 ln vl 200 amps or less • 1 100.70 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: 1 0,0 S W S L4 44 144 -€jv 6 S t t) V. Over 1,000 amps or volts 552.26 2 .
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: j &A - 2 ,2 — 3 relocation
Phone: (SO3) 70 q' — 0 101 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, le.. •, rent, o • ' xchan l accordin! • k! -447, 449, 670 and 701. 401 amps to 599 amps ' 168.54 2
• Branch circuits — new alteration or extension ' l er lane)
I Owner Signature: _ _ Date: 1 15 1201 A. Fee for branch circuits with
Q(
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, r 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: Signor outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited -energy
T` Business name: /l,� jj� ll — panel, alteration, or extension. Page 2 2 "
(/ Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Clty/State /ZIP: Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (%2 hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: I/70, ( Z
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): /A.99
TOTAL PERMIT FEE: is /t 0 9
Authorized signature: 6
This permit application expires if a permit is not obtained within 18
Print name: Date: • days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\ Building \Permirs\ELC- PermiiApp.doc 07/01/10 ) 440 -4615T(I 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*
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❑ 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
❑ 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