Permit I y u CITY OF TIGARD ELECTRICAL PERMIT
i ii 2. COMMUNITY DEVELOPMENT Permit #: ELC2013 -00192
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/27/2013
Parcel: 1 S134DD01200
Jurisdiction: Tigard
Site address: 11675 SW TIEDEMAN AVE
Project: Pena Subdivision: 2004 -050 PARTITION PLAT Lot: 2
Project Description: Install new service and (3) branch circuits in barn.
Contractor: OWNER Owner: GUTIERREZ, JOEL PENA
GODINEZ, ROSA PENA
11675 SW TIEDEMAN AVE
TIGARD, OR 97223
PHONE:
PHONE: 971- 222 -7131
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 03/27/2013 $100.70
Specifics: amps or less
3 crt Branch Circuits w /Purchase 03/27/2013 $22.26
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 03/27/2013 $14.76
Electrical
Type of Const:
Occupancy Grp:
Total $137.72
Required Items and Reports (Conditions)
This permit is iss 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 i ccordance wi pproved 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 ENTION: Oregon I • r- • •' :s y• to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 0010 through OAR 952 -00 -9090. Y• y obtain a copy of the ules or direct questions to OUNC by calling 503.232.1987 or 1.800.332. 44.
Issue y: Permittee Signature: d C
OWNER INSTALLATION ONLY
The installation is being made on property I own wh unt intende or sa �,l lleaasse o 2
OWNER'S SIGNATURE K.--------.1 v ? / Wei Date: c /� 7 / 7
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 603.639.4175 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 APPIicati rF D FOR OFFICE USE ONLY
, °
C 13125 ity SW of T all g i and V F.. � Received sl n, + 3 c0al)J
/�-
Permit �0�3 60/9 PitNo.: e2. -
`J o� '-pC
H Blvd., A Tigard,OR 972 Plan Review
Phone: 503.718.2439 Fax: 503.598. lIR r� 2 I 2 O 3 Date/By:
Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris El See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE ONIAIfNG DIVISION 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 ", "I - ", "I - ",
)� 100HP or more. occupancy.
Job no.: Job site address: i (to, 5 ) � f.t9 / Il) ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ 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 Qtr. 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
S �1 + ' Limited energy, multi - family 75.00 2
��t.4D \ ( Q 31 C_-- 4- -Y�- c 1 C �( - l.J --&-L 1 S residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
ti) 2..t . ' 200 amps or less I 100.70 //. 7 2
❑ PROPERTY OWNS ❑ TENANT 201 amps to 400 amps 133.56 2
r , 401 amps to 600 amps 200.34 2
Name: \ h �5 O C ‘ ( Y1 v1 (.f.I � 601 amps to 1,000 amps 301.04 2
Address:
t ,
! 1 P � rn � �/'� G (� � � Over 1,000 amps or volts 552.26 _ 2
a d / � Temporary services or feeders installation, alteration, and /or
City/State/ZIP: v Y
'^, `T relocation
Phone: ( p 1 ) s� Fax: (fib ) 200 amps or less 59.36 1
1 L2.�� f p 1 / �� Z 2 � 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 excha cording to 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature �� t° CA_ Date: A. Fee for branch circuits with `
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 3 7.42 22.4, 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'I branch circuit • 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
Y 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: O L. i'v €12- 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 ('h hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: o Subtotal: �1', , 9
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): / 9 . 74
TOTAL PERMIT FEE: ! I 32. 72
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.
Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp doc 07/01/10 440 -46t ST(11/05 /COM/WEB
Electrical Permit Application - City of Tigard k _ wM ;
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
F 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
•
❑ Nursc Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other •
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
t l
1:\BuildingWermits\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
11675 SW TIEDEMAN AVE, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
04/10/2013 00:00
ELC2013-00192
PASS - No C of O
Violation Summary:
Inspector Contractor