Permit 1 u CITY OF TIGARD ELECTRICAL PERMIT
11- . COMMUNITY DEVELOPMENT Permit #: ELC2013 -00072
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/29/2013
Parcel: 1S135DB02900
Jurisdiction: Tigard
Site address: 11515 SW 91ST AVE
Project: Hampton Subdivision: CHARBEN Lot: 12
Project Description: (1) branch circuit to reconnect furnace
Contractor: ALTEC ELECTRIC LLC Owner: HAMPTON, KENNETH B &
9655 SW NORTH DAKOTA ST STE #23 KNOLL, LAURA D
TIGARD, OR 97223 11515 SW 91ST AVE
TIGARD, OR 97223
PHONE: 503 - 888 -9505 PHONE:
FAX: 503 - 372 -5501
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 01/29/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/29/2013 $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 permit sue• • • - t to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do in accordance with a• •rove• - •ns. 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 law equires you to follow the rules adopted by the Oregon Utility Notification Center. Thos z rules are set forth in OAR
95. 001 -0010 thro gh OAR 952 -r • 090 . You ay obtain a copy of the rules or direct questions to OUNC by callin 503.232.1987 or .800. 2.2344.
Is- ed By: — � Permittee Signature:
f -
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:
• NTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' -'141 - . i 1 Date:
LICENSE NO.
can 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 •; S • - GENE FOR OFFICE USE ONLY
City of Tigard
Received
Permit No.: G . L s , A e..."4 �� /�� 7,2_, ° 13125 SW Hall Blvd., Tigard, OR 91AN 2 9 2013 DateB :
Plan Review l /
' 0 : Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: I ` a D' 3 _oer>'j `,
T 1 GA RD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISIOFI Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ 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
❑ 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 ",
Job no.: Job site address: //Lc /S (Al 9� S.* 100HP or more. occupancy.
,n ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 7 go 0-cI OS , ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: (3T� I) ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Oty. 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
sq. 75.00 2
DESCRIPTION OF WORK ( with above 4• ft. )
O � `
ln n J' I
Limited energy, multi-family
i J ^ p� Q— Q.3 R o / � u residential (with above sq. q. 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
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
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 I ❑ 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 5 2
Contact name: branch circuit f ( O
Each add'I 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: A �Q_ F t_JC_, l e_ es._ C panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 9 6JS S, (,() o a-4- D , $ 4 • so (' 2 g Additional inspection (1 hr min) 66.25/ hr
Indust
City/State /ZIP: / ' C-01 /f 0 _ 0 n_ /) 1223
Investigation
plant ( t (1 min) 66.25/ hr
"f Industrial (1 hr min) 78.18/ hr
Phone: Q F ax: , ( Inspections for which no fee is
( Sb3) $ fig - / SOS (5�3) 3 0 2 - specifically listed (V2 hr min) 90.00 / hr
CCB Lic.: 1S,6 710 Electrical Lic.: 24 - 035 , : uprv..' i .: / 90 S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: / Subtotal: b 6, , / 5
Plan review (25% of permit fee):
Print name: Y,e,21R, ( 44 S Date: /_ 247_ /? State surcharge (12% of permit fee): , 9
7
TOTAL PERMIT FEE: (.jl
Authorized signature: T his permit application expires if a permit is not obtainneee within 180
Date: qq 9 _ /j days after it has been accepted as complete.
Print name:
(/ I K - 7 O2 s1A ( -, Number of inspections allowed per permit.
1:\ Building \Permits\ELC-PermitApp.doc 07/01/10 440 -4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard ;
Page 2 - Supplemental Inform ition
LIMITED ENERGY PERMIT FEES:
, RESI!DENTIAL. WORK ONLY: --- d- 1
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:\ BuildingTermits \ELC- PermilApp.doc 07 /01/10