Permit CITY OF TIGARD ELECTRICAL PERMIT
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I:. COMMUNITY DEVELOPMENT Permit#: ELC2013 -00303
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 06/03/2013
Parcel: 2S 103DA06900
Jurisdiction: Tigard
Site address: 10925 SW MIRA CT
Project: Reiney Subdivision: MIRA PARK Lot: 7
Project Description: Grounding due to water service replacement.
Contractor: OWNER Owner: REINEY, MICHAEL G
10925 SW MIRA CT
TIGARD, OR 97223
PHONE PHONE 503 - 592 -0299
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 06/03/2013 $67.84
Specifics:
1 ea 12% State Surcharge - 06/03/2013 $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 Codes and all other applicable law. All work will
be done in : -- •rdance wi —proved 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. AT ' NTION Oregon la r- • . s ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 •010 through OAR 952-0# -0090. • u may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 8800 332.2344
/ �� ,.
Issu • By: / Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not inte ded for sale, lease or rent.
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OWNER'S SIGNATURE f " "'vr , / Date: io/--7/ 7 2
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.
Thls 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 D� /- roll OI FlcI USE ONLY
City of Tigard RECEI Da te/By: Cv 3 / 3 / Permit No : ELe�o /3 eX2$3
1 Pl ° 13125 SW Hall Blvd., Tig'ard,OR 97223
an Review
C Phone: 503.718.2439 Fax: 503.598.1960 JU Date/By: Other Permit:
0 3 2013 Juris ® See Page 2 for
- I - I G A R l) Inspection Line: 503.639.4175 Date R eadylBy . g
Internet: www.tigard -or.gov Notified/Method: Supplemental Information
CITY OFTIGARD
TYPE OF PLAN REVIEW
`'DING DIVISION PLAN
check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction A( Addition/alteration /replacement
❑ 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
I - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations buildings
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system.
()Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: i p9 2.3 Al /kla G r 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/ State/ZIP: r/ / A.120 G 2 q 2 Z ZC.3 ❑ 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: //o 7 -7f PAT Description I Qty. 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. R. 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
A-00 �DV Ub goes residential (with above sq ft.) 75.00 2
Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and/or relocation
OWNER ❑ TENANT 200 amps or less 100.70 2
APROPERTY
201 amps to 400 amps 133.56 2
Name: Pile H"ALSL e`/ iii 401 amps to 600 amps 200.34 2
Address: /b 9 ys . c.' /n /'2 A- G J 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: 77 ‘/9'de /i d 2 of J z,23 Temporary services or feeders installation, alteration, and/or
Phone: (5D3) 6 3 99 9 f-7 Fax: ( ) relocation
200 amps or less 59.36 1
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, o excha e, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 54 2
Owner signature: Date: 0//3 Branch circuits — new, alteration, or extension, per panel
❑ APPLICAN I ❑ CONTACT PERSON 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
Miscellaneous (service or feeder not included)
City/State /ZIP:
Each manufactured or modular 67.84 2
Phone: ( ) Fax: : ( ) dwelling, service and/or feeder
Reconnect only / 67.84 f, 7. $y 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: D lAD I_a En— Signal circuit(s) or limited -energy See
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 (I hr min) 66 25/ hr
Phone: ( ) Fax: ( ) Industrial plant (1 hr min) 78.18/ hr
Inspections for which no fee is 90 00/ hr
CCB Lic.: Electrical Lic.: Suprv. Lic.: specifically listed (V2 hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:
Subtotal: (D'j. $
Print name: Date: Plan review (25% of permit fee): - —
�/ State surcharge (12% of permit fee): 9. 1 y
Authorized signature: )( ,14t,,.,til / �j 0?-444 613//3 TOTAL PERMIT FEE: 75 . 7 g
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.
1:\ Building \Permns\ELC_PennitApp_ELR ERE doc Rev 05212013 440- 4615T(1I /05 /COM/WEB
Electrical Permit Application — City of Tigard
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Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined ... $75.00 Description I Qty. I Pee I Total 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
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301 04 2
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El Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva (fee in accordance with 552.26 2
El Heating, Ventilation and Air Conditioning OAR 918 - 309 -0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ 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
charged at an hourly (I hr min) 66.25/ hr
Inspections for which no fee is 90.00 / hr
specifically listed (fe hr min)
r 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
❑ Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
El Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
❑ Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
❑ Nurse Calls
El 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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