Permit CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit #: ELC2013 00320
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/10/2013
Parcel: 1 S134DB00900
Jurisdiction: Tigard
Site address: 11115 SW 114TH PL
Project: WERNER Subdivision: WINTERS ADDITION Lot: 3
Project Description: Install new 200 amp panel
Contractor: ALTEC ELECTRIC LLC Owner: WERNER, MARIL
9655 SW NORTH DAKOTA ST STE #23 11115 SW 114TH PL
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 888 -9505 PHONE:
FAX: 503 - 372 -5501
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 06/10/2013 $100.70 •
Specifics: amps or less
1 ea 12% State Surcharge - 06/10/2013 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports,(Conditions)
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This permit is iss - • •■ 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 with app • ed plans. This permit will expire if work is not started within 180 days of issua' -, or if work is suspended for more the 180
days. • TENTION: Oregon law re•..re ou to f•Ilow the rules adopted by the Oregon Utili• .. >_:;:,Wt.• Center. Those rules are set forth in OAR
952 -0' 1 -0010 thro • h OAR 952- 001 -009 • You may • •tai a copy of the rules or direct questions to Oj1 • by calling 503.23 or 1.800.332.. 44.
. \I/
Iss ed By: - — —L I/ ./ .� _. Permittee ature: aui (
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' _^� I , ��7 ir r c - `_ Date:
LICENSE NO. I / ��`
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 Soli of i icl. USE ONLY
City of Tigard Received
514 Permit No.: �� C,
° 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
• tI .: Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
. 1 . 1 G A R 1) Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TY PE OF WORK PLAN REVIEW
❑ New construction L vJ 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 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
['Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
100HP or more. occupancy.
Job no.: Job site address: lips S , la1 • tilt �= L
� 0 Six or more residential units. 0 Recreational vehicle parks.
City/State /ZIP: t ❑ Health -care facilities. ❑ Supply voltage for more than
T 6 �' � (� 2 L 3 ❑ 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 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. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
1 Limited energy, multi - family 75.00 2
1 W s ° L NH �o wwe iA -NC(_ s)"11.7 r po l.,/ i QS _ residential (with above sq. ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less / 100.70 /O.. 7 0 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 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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT 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
City/State /ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
Phone: ( ) Fax: : ( ) dwelling, service and/or feeder
Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: A Ike e _ £ta, „L Li. Signal circuit(s) or limited-energy See
panel, alteration, or extension. Page 2 2
Address: bS 5 S . w . &Qastl OA ((ik s4 , Cu 17 02 - 3 Each additional inspection over allowable in any of the above
Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: en 6 6 ILQ 1 0 1 q722._ 3 Investigation (1 hr min) 66.25/ hr
Phone: (.S03) gg8_ i So S Fax: ( 503 ) 3 4)- - S 50( Industrial plant (1 hr min) 78.18/ hr
Inspections for which no fee is 90.00 / hr
CCB Lic.: 15'6 '7zo Electrical Lic.: 4 _ . uprv. Lic.: / q( 3 -S specifically listed (% hr min)
// ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: / i' C_ Subtotal: /cV '7e
Print name: , ea- Q .( a e_4( s Date: 6 -- (CJ — (. Plan review (25% of permit fee):
State surcharge (12% of permit fee): / .
Authorized signature: L
TOTAL PERMIT FEE: / / .7 '
T his permit application expires if a permit is not obtained within 180
Print name: UAK 0 ff - 6(2 -; S (4 fr.,0 Date: 6_ ---to --13 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\BuildingWermiti\ELC PermitApp_ELR_ERE.doc Rev 05/21/2013 440- 4615T(11 /05 /COM/WEB
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Electrical Permit Application — City of Tigard
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 Fee 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
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>I00 kva (fee in accordance with
OAR 918- 309 -0040) 552.26 2
❑ Heating, Ventilation and Air Conditioning -
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 66.25/ hr I
charged at an hourly (I hr min)
Inspections for which no fee is 90.00/ hr
specifically listed (/ 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
❑ Audio and Stereo Systems da after it has been accepted as complete.
• Number of inspections allowed per permit.
❑ Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El 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
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