Loading...
Permit y CITY OF TIGARD ELECTRICAL PERMIT ; • 1 ' COMMUNITY DEVELOPMENT Permit #: ELC2013 00207 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/04/2013 Parcel: 1 S 134DC09100 Jurisdiction: Tigard Site address: 11454 SW TWIN PARK PL Project: Strom Subdivision: TIGARD PARK Lot: 7 Project Description: Change out panel from 100 amp to 200 amp Contractor: DICKINSONS ELECTRIC Owner: STROM, KATHLEEN D 8449 SW BARBUR BLVD 11454 SW TWIN PARK PL PORTLAND, OR 97217 TIGARD, OR 97223 PHONE: 503 - 246 -3550 PHONE: FAX: 503 - 213 -6049 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 04/04/2013 $100.70 Specifics: amps or less 1 ea 12% State Surcharge - 04/04/2013 $12.08 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 Required Items and Reports (Conditions) This permit is • su•I- o 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 with ap• •ved 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: Oregon law -qui -s • • to follow the rules adopted by the Oregon Utility Notifi Center. Those rules are set forth in OAR 952 -00 -0010 thr• ugh OAR 952 -0% 0090. Y• =y obtain a copy of the rules or direct questions to OUNC by ing 503.232,1987 or 1.800.332.23 ' . Iss ed By: / . / P ermittee S •nature: _ . _ / /(t N —r <G� 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: i _ CONTRACTOR INSTALLATION ONLY ' SIGNATURE OF SUPR. ELEC' / • :fr".11 / (eP-4---- Date: y ©/ LICENSE NO. 3fQQ- 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 Application iou 01 :1 I( I I SE OM 1 City of Tigard RECEIVED RDate/Bed I / Permit No.: 6.....6 3 2 ; , • • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.1960) 04 2013 Date/By: Other Permit: I I c , RD Inspection Line: 503.639.4175 rr O Date Ready/By: June. la See Page 2 for Internet: www.tigard -or.gov Notified/Method: Supplemental Information TYPE CITY 9F T1�iAllL IllifiN DIVISION PLAN REVIEW ❑ New construction Eia Addition/Aeration/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 p i 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. A ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: Job site address: ' `, �-� Q y p/ 100 or more. occupancy. fl i4'C M I f V � 1 T7 "ice T W - ❑ Six or more residential units. ❑ Recreational vehicle parks. Clty/State /ZIP: ❑ Health - facilities. ❑ Supply voltage for more than 600 volts nominal. ��/� �p t �M) 0 O V 1 � ❑ Hazardous locations. Suite/bldg. /apt. no.: I Project name: e` ❑ Service or feeder 600 amps or more. job site: ���`��'' - FEE SCHEDULE Cross street/directions to J '�� a ..'� C.41' /TO INS 0 ��� l' L t Description I Qty. I Fn. 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 9 ^M ,Opik TO O W � Limited energy, multi-family iq. 75.00 2 `Ft1 J residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less / 100.70 400,70 2 lb PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: L A.nl _fas+ 1� 601 amps to 1,000 amps 301.04 2 Address: t 1�k5� S\ - t'a 1AN4'44-re--. Over 1,000 amps or volts 552.26 2 Temporary City/State /ZIP: 10 � '1� relocation services or feeders installation, alteration, and/or Phone: ( ) Fax: ( ) 200 amps or less 59.36 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 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 ra APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: +jt urlop ti5 Lt g_ iL B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: I ".AviO , u n r N (�0 branch circuit _ " r"""� Each add'I branch circuit 7.42 2 Address: coq ( UVjl<,��/ 41.4i2 Miscellaneous (service or feeder not included) City/State/ZIP: 11 �� (/� ^�`�"'_ ' /) Each manufactured or modular — Ci ty � lr, i ) vs `ta 0(L dwelling, service and/or feeder 67.84 2 Phone: (cc)) ) 2'* 3 , ; ;G - 0 Fax: : ( ) _Reconnect only 67.84 2 —' +1� — 1 & ^ C 1N�7N4� t , I ( Pump or irrigation t in g e 67.84 2 E - mail: 1' CV D17 (OM ` 1 Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited-energy Business name: f panel, alteration, or extension. Page 2 2 tat'., re ,1 0 C Each additional inspection over allowable in any of the above Address: c?,t;(ae jo /SNl)�, ;) Additional inspection (1 hr min) 66.25/ hr `` �, �t , �- V`^ ( ' ],, Investigation (1 hr min) 66.25/ hr City/State /ZIP: �UI'� ► N'9�jf) — t Z — I I Industrial plant (1 hr min) 78.18/ hr Phone: ti33 l�* „ ' t, Fax: ( ) Inspections for which no fee is 90.00 / hr J specifically listed (V2 hr min) CCB Lic.:b 5" Electrical LicRe 1 ) Suprv. Lic.: 3/0- ELECTRICAL PERMIT FEES Suprv. Electrician signature, requir : • f Subtotal: �Qp. 70 P- Plan review (25% of permit fee): Print name: tAii. l , I` _ — R Date: • � State surcharge (12 %ofpermit fee): /. • CT ��, TOTAL PERMIT FEE: / l 7,- 7 9 Authorized signature: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it bas been accepted as complete. N um b er of inspections allowed per permit. I:\ Building \Permits\ELC- PermitApp.doe 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 El Garage Door Opener* El Heating, Ventilation and Air Conditioning System* El Vacuum Systems* El Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: El Audio and Stereo Systems El Boiler Controls ❑ Clock Systems El Data Telecommunication Installation El Fire Alarm Installation ❑ HVAC El Instrumentation El Intercom and Paging Systems El Landscape Irrigation Control* El Medical ❑ Nursc Calls ❑ Outdoor Landscape Lighting* El Protective Signaling El 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