Permit rt
CITY OF TIGARD ELECTRICAL PERMIT
111
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00027
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/14/2013
Parcel: 2S 109AD00100
Jurisdiction: Tigard
Site address: 12585 SW BULL MOUNTAIN RD
Project: Islas Subdivision: BLUE RIDGE Lot: 1
Project Description: Bathroom remodel
Contractor: OWNER Owner: ISLAS, SERGIO
12585 SW BULL MOUNTAIN RD
TIGARD, OR 97224
PHONE:
PHONE: 503 - 701 -7793
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 01/14/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/14/2013 $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 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 - • • -nc= • 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. A NTION: Oregon - , •1 -s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 0010 thr• gh OAR 952-0 -0090. Y. may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344,
Iss • ed By: _ mot. By: —/A.4 � , Permittee Signature: (.0 �•�J �jJ
OWNER INSTALLATION ONLY
The installation is being made on propert wn which is not intended for sale, lease or rent.
OWNER'S SIGNATURE t. cO 77) 4 J 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 ApplicariEcovED FOR OFFICE USE ONLY
Ci
Received ['� �� ^ _ e: 60„ of Tigard Permit No.: G
tY Date/B : l _ ��
1 1 1 1
• 13125 SW Hall Blvd., Tigard, OR 97j 1 4 2013
G Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
El New construction ❑ Addition/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
❑ I- 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 ", "l -2 ", "l -3 ",
/ /��
I00HP or more. occupancy.
Job no.: Job site address: ) S. S, LA., L � Sae (R d ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: "7 JC oycl Or g ZZ ❑ Health -care facilities. ❑ Supply voltage for more than
/ ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: J'L
0 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
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
616/ / h ae mode/ Li esi energy, mu ove s 75.00 2
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
f y(t) —�- �� J c
601 amps to 1,000 amps 301.04 2
Address: " „i ) ( 6S $ w e ki fed Over 1,000 amps or volts 552.26 2
/ Temporary services or feeders installation, alteration, and/or
City/State /ZIP: 7, %' or ? 22 Li relocation
Phone: 5(23) O/ _ ? 3 Fax: ( ) 200 amps or less 59.36 1
3 201 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 e, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
�-p Branch circuits - new, alteration, or extension, per panel _
Owner signatue «—L J� Q S Date:/-13 - / 3 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 I 56.18 -5 /V 2
Contact name: branch circuit
Each add'I branch circuit / 7.42 7. [h2, 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: Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Investigation (1 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 (V2 hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: (o ,(pig
Plan review (25% of permit fee): ,---.
Print name: Date: State surcharge (12% of permit fee): 7- (05
TOTAL PERMIT FEE: 7 / , 2-3
Authorized signature: 1 tD �__I_J'1 p application expires permit permit a bcation ex Tres if a ermit is not obtained within 180
. days after it has been accepted as complete.
Print name5 ),:y/ p ” $ Date: ', /3_ / 3 • 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*
❑ 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
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12585 SW BULL MOUNTAIN RD, TIGARD, OR,
97224
Residential - Electrical
199 Electrical final
05/10/2013 00:00
ELC2013-00027
PASS - No C of O
Violation Summary:
Inspector Contractor