Permit a CITY OF TIGARD ELECTRICAL PERMIT
111 s COMMUNITY DEVELOPMENT Permit #: ELC2013 00232
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/23/2013
Parcel: 2S105DA17700
Jurisdiction: Tigard
Site address: 14610 SW CATALINA DR
Project: Al- Madani Subdivision: PACIFIC CREST Lot: 65
Project Description: (1) reconnect only
Contractor: OWNER Owner: AL- MADANI TAHA
14610 SW CATALINA DR
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 04/23/2013 $67.84
Specifics:
1 ea 12% State Surcharge - 04/23/2013 $8.14
. Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty ,Q•des and - - . • • - • e law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of ssuanc- •r if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notif -tion enter. Those rules are set forth in OAR
952- 001 -0010 through OAT - 001 -00 0. You ma obtain a y of the rules or direct questions to OUNC by callin• 503 32.1987 or 1.800.332.2344.
Issued By: e 1 � Permittee Signature: a _
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' 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 Permit Application FOR OFFICE USE ONLY
City of Tigard RECEIVED DateBy: 4 3 ( 4� Permit No.: 2L / 3 - y 3,.--,
13125 SW Hall Blvd., Tigard, OR 972 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 7 Date By: Other Permit:
I I e . ;� It I ) Inspection Line: 503.639.4175 2 3 2 3 Date Ready/By: lur r la See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
cif
TTISPPIl :3r' Wr PLAN REVIEW
❑ New construction ❑ Addition /alterra t Please check all that apply (submit 2 sets of plans w /items checked below):
r , p ❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition Other: 61. .), S U � ( � � \--- fiM, a IA 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
- 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 - ", "1 - ",
Job no.: I Job site address: / L/. /0 5 W v \ Six or or more residential Recreational
/.f ( \J ❑ Six or more residential units. ❑R vehicle parks.
City/State /ZIP: / 0 0 2 01---)2,?....- ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: ❑ 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'l 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
Limited energy, multi- family 7500 2
( ��� 0303-Y\ O(4 residential (with above sq. ft.)
III Renewable Enerow I ❑ See Page 2
Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( )
Fax: ( ) relocation
200 amps or less 59.36 1
Owner installation: This installat a on property that I own which is not 201 amps to 400 amps IN 125.(lit
intended for sale, lease, rent o ge according to ORS 447, O an 701/(1 401 amps to 599 amps 168.54 2
Owner signature: Dat Y, B ranch circuits — new, alteration, or extension, per panel
❑ APPLIC I ❑ CONTACT P RSON A. Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
B. Fee for branch circuits without
Contact name: service or feeder fee, first 56.18 2
branch circuit
Address: Each add'I branch circuit 7.42 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
Phone: ( ) I Fax: : ( ) dwelling, service and/or feeder
Reconnect only V 67.84 2
E - mail: Pump or irrigation circle► 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited- energy
Business name: panel, alteration, or extension. Page 2 2
Address: Each additional inspection over allowable in any of the above
Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Phone: ( ) I Fax: ( ) Industrial plant (1 hr min) 78.18 / hr
Inspections for which no fee is
CCB Lic.: I Electrical Lie.: I Suprv. Lie.: specifically hr
fically listed (% hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: J Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: 75, t
, , This permit application expires if a permit is not obtained within ISO
Print name:a —
Date:
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building\ Permits \ELC_PermitApp_040913.doc 440 4615T(1 1/05/COM/WEB
Electrical Permit Application — City of Tigard
Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description Qty. Fee I Total
Fee for all residential systems combined ... $75.00 I I I *
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
El Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener*
>100 kva (fee in accordance with
OAR 918- 309 -0040) 552.26 2
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
El Vacuum Systems* >100 kva— no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/ hr
charged at an hourly (I hr min)
Inspections for which no fee is 90.00 / hr
specifically listed (Y hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system • $75.00 Subtotal:
(SEE OAR 918- 309 -0000) Plan review, if required (25% of permit fee):
State surcharge (12% of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
El Audio and Stereo Systems days after it has been accepted as complete.
* Number of inspections allowed per permit.
El Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
(:'Build ing\Permi ts\ELC_PermitApp_040913. doc
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
14610 SW CATALINA DR, TIGARD, OR, 97223
Residential - Electrical
115 Electrical service
04/24/2013 00:00
ELC2013-00232
PASS
Violation Summary:
Inspector Contractor