Permit n CITY OF TIGARD ELECTRICAL PERMIT
11 1 1 - COMMUNITY DEVELOPMENT Permit #: ELC2013 -00116
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/19/2013
Parcel: 2S 103DA03290
Jurisdiction: Tigard
Site address: 10655 SW PARK ST
Project: Krager Subdivision: DERRY -DELL NO.2 Lot: 35 & PT
Project Description: Upgrade existing panel, add feeder for new shop, (3) branch circuits and low voltage for data.
Contractor: OWNER Owner: KRAGER, ROBERT WARREN
10655 SW PARK STREET
TIGARD, OR 97223
PHONE: PHONE: 360 - 903 -4861
FAX:
FEES
Quantity Description Date Amount
2 ea Services or Feeders - 200 02/19/2013 $201.40
Specifics: amps or less
3 crt Branch Circuits w /Purchase 02/19/2013 $22.26
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 02/19/2013 $35.84
Electrical
Type of Const: 1 ea Signal circuit or Limited 02/19/2013 $75.00
Occupancy Grp: Energy Panel
Total $334.50
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 - - • - • e 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. • • ENTION: Ore, • • law . • .'res you to follow the rules adopted by the Oregon Utility Notification Center. hose rules are set forth in OAR
952-1 through OAR 95 • • -0090. • • may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1. 0.332.2344.
/'
Is - ed By: 1 e _ ■._■ _:.i / Permittee Signature:
�/ ,,-,.,.t- /G ..
OWNER INSTALLATION ONLY
The installation is being made on property I own which i not intended for sale, lease or rent.
OWNER'S SIGNATURE tx /--- °""" - '�-� Date: ,P// 7 / ,'y
CONTRACTOR INSTALLATION ONLY r '
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 City ADDIi va i N FOR OFFICE USE ONLY
'' Tigard Dat EL ,�� ��� -
Ci of Ti and ve a , i i irra W� / Permit No.:
lo 13125 SW Hall Blvd., Tigard, OR OW 1 9 Z0i3 Plan Review
C Phone: 503.718.2439 Fax: 503.5987f960` Date/By: Other Permit:
1" I G A R D Inspection Line: 503.639 CITY ®� TIGARD Date Ready/By: Juris: El See Page 2 for
Internet: www.ti g ardor. ov GGaa Ft ((�� DIVISION
/� Notified/Method: Supplemental Information
TYPELA�RIC DIVISION PLAN REVIEW
El New construction 01 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 El 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 ", "I - ", "I - ",
Job no.: Job site address: /0i5S S. (.J: P1 IooHP ore res Recreation. •
G• r k S e r ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
r, -� a ,-- 4 d r Q 9u h 97 1 � 3 ❑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: 1 /2.. bin`k id" i_ ec Al lSec r it Description I Qtr. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
0.P S W , CL1-1 C a '-) S. LAJ, WA-4 lc; hS Includes attached garage.
Subdivision: nn ,, / Lot no.: 1,000 sq. ft. or less 168.54 4
pa, ��� D. �/ /V � Ea. add'I 500 sq. ft or portion 33.92 1
Tax map /parcel no.: Z / 0 3 J A 32 90 Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
Its°e 1--0 d e 0_7( ; s 44 wj p R r s ( a K,1 e-J,.../ ..Sr "2 v,' e. residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
" Al,/, -,.j S-4- 0 p — - }Tot 0.1,5L e, 200 amps or less 41 100.70 9/l,I149 2
®' PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
r Name: bat /-v p ;- r s.z5 ,e 601 amps to 1,000 amps 301.04 2
Address: r /a 6 Ss ---- S, (Al , "1.---/c S f,/t e '7F- Over 1,000 amps or volts 552.26 2
Temporary City/State /ZIP: 7 f C� or e 97 2 23 relocation
or feeders installation, alteratioh, and/or
Phone: (AD ) 903 — 4'86 / Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This inst llation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, r exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
l'X
Owner signature .c e...........— ' Date: z - / -7 ` t 3 A. Fee for branch circuits with ^/
APPLICANT ❑ CONTACT PERSON above service or feeder fee S 7 42 �a. 2
each branch circuit
Business name: B. Fee for branch circuits without
" service or feeder fee, first 56.18 2
[y
Contact name: !•t i. t.e r` IC A_• .ems branch circuit
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: ( 36 0) ?O — 4 / Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting if 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy �7C
Business name: O�tiv �. a— panel, alteration, or extension. / __ Pie 2 ! v 2
Each additional inspection over allowable in any of the abov
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 (% hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: o Subtotal: O(9 9... 44, Plan review (25 /o of permit fee):
Print name: Date: State surcharge (12% of permit fee): 35 . grf
TOTAL PERMIT FEE: 3 t{.SO
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
N um b er of inspections allowed per permit.
I:\Building\Permits\ELC- PermitApp.doc 07/01 /10 440- 4615T(l1/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information ,
LIMITED ENERGY PERMIT FEES:
j 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*
El 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
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10