Permit •
d g ELECTRICAL PERMIT
CITY OF TIGARD
)1-
PERMIT #: ELC2006 -00646
COMMUNITY DEVELOPMENT DATE ISSUED: 11/13/2006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 103 B C - 02500
SITE ADDRESS: 12355 SW ALBERTA AVE ZONING: R -4.5
SUBDIVISION: CANOGA PARK LOT : 009 JURISDICTION: TIG
Project Description: 200amp service change out.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
DANIEL & MELODIE KELLY OWNER
12355 SW ALBERTA ST
TIGARD, OR 97223
Phone: 503 - 579 -5446 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 1 1/13/200( $66.85
[TAX] 8% State Surcharge 11/13/200( $5.35
Total $72.20 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Tho a rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct question to OUNC at•5 .246.6691.800. 2.2344.
ma c, ,')/ \ '
Issued By: eLr�Yae !� 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'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 Applicatiii ECE IVED I Olt OFI ICL (iSE ONL.1V
•
City of Tigard NIQV° 1 Received
3 2006 DaDate/13 . / 3 As, r ► Permit No.: : Zd.D6 _ .-
q 13125 SW Hall Blvd, Tigard, OR 9722 Plan Review
III _ Gv ‘6$1... . Phone: 503.639.4171 Fax: 503.59 OF TIGARD Date/S . Other Permit:
T I G n It D Inspection Line: 503.639.4175 Date Ready/By: 65 See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION 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):
El Demolition ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ O ther: where the available fault =rent ❑ 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
. ❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ,�j� ❑ Addition of new motor load of ❑ "A", "E ", ' I -2 ", "1 -3 ",
Job no.: Job site address: I Z% 5 5,(,(J, •I . " Sf 100HPormore. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: �� o /Z7 ❑ Health-care ocat es. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
job site: Description FEE SCHEDULE
• Cross street/directions to
J I Qty. I Fee. I Total
New residential single -or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
../ N�U r (. t, I att -1.- residential (with above sq. ft.) 75.00 2
`
_n 'k 1 ) j l �/ ((( J���� a ll e / I Services or feeders installation, alteration, and/or relocation
� t 200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: Van I -C.l "a IOd .(((��� ! .P II i 401 amps to 600 amps 160.60 2
� 601 amps to 1,000 0 amps 240.60 2
� -
Address: 1 � - (1,6 lfO, , Over 1,000 amps or volts 454.65 2
• City/ State/ZIP: -- Ti �)/ . OR C) Temporary services or feeders installation, alteration, and/or
relocation
Phone: 603) t — " / 2.)--1-( p Fax: ( ) 200 amps or less / 66.85 1
Owner installation: This installation is bein I made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sal I s-, .- nt, or ex hange a •rding to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature:
/ JS ���. / Date: �/ �/ 3o (_ Branch circuits — new, alteration, or extension, per panel
. A. Fee for branch circuits with
• ❑ APPL ANT I / ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: first branch circuit
Address: Each add'I branch circuit 6.65 _ 2
Miscellaneous (service or feeder not included)
• City / State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
• Signal circuit(s) or limited -
Business name: energy panel, alteration, or
•
Address: extension. Describe: Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
I Per inspection 62.50
Phone: ( ) Fax: ( )
Investigation per hour (I hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: ( . "i
Print name: Date: Plan review (25% of permit fcc):
( � State surcharge (8% of permit fee): 2
Authorized signature: , TOTAL PERMIT FEE: &
Print name: Date This permit application expires if a permit is not obtained within 180
days after it has been accepted as con ete.
• Number of inspections allowed per permit. 7 a - a -4)
I:\ Building ennits'ELC- PermitApp.doc 0523/06 440-46I5T(I1 /0S /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- 260 -260)
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
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