Permit q CITY OF TIGARD ELECTRICAL PERMIT
g ' COMMUNITY DEVELOPMENT Permit #: ELC2013 -00377
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/03/2013
Parcel: 2S111CC17700
Jurisdiction: Tigard
Site address: 10340 SW HIGHLAND DR
Project: Opoka Subdivision: SUMMERFIELD NO.4 Lot: 228
Project Description: Regrounding due to water service replacement
Contractor: OWNER Owner: OPOKA, ROBERT
OPOKA, ROBERT 10340 SW HIGHLAND DR
10340 SW HIGHLAND DR TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 503 - 684 -8473 PHONE: 503 - 684 -8473
FAX: •
FEES
Quantity Description Date Amount
1 ea Reconnect Only 07/03/2013 $67.84
Specifics:
1 ea 12% State Surcharge - 07/03/2013 $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 'q.. .an ubject to the regulations contained in the Tigard Municipal Code. State of OR. Specialty Codes and all other applicable law. All work will
be done ' accordance w • approved 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. TTENTION: Oregon :w =s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 1 -0010 thro gh OAR 952 -. ' -0090 Y u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss ed By: — � l� �� ! ►� /- ` Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on prope wn which is not intended for sale, lease or rent.
r ly
OWNER'S SIGNATURE 0 ( Date: 7/ 3/! 3
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 A t 1lic,,,L.1. 2 FOR OI'I'ICE USE ONLY
City of Tigard / `t � � Date/B / 3 f 1 Permit No.: r ze w /5- 377
° 13125 SW Hall Blvd., Tigard, OR 7 23 Plan Review u
C ' Phone: 503.718.2439 Fax: 50396®3 3 Date/By: Other Permit: /�/3 �2/1 4'
TI G K u Inspection Line: 503.639.4175 Date Ready/By: turfs: ® See Page 2 for
Internet: www.tigard or.gov CITY OFTIGARD Notified/Method: Supplemental Information
TY1lMiI IAINGD1V , -: - PLAN. REVIEW •
❑ New construction Et 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
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 ", "l -2 ", "l -3 ",
Job no.: Job site address: / 100HP or more. occupancy.
L �✓ / ) ✓1 ? Pia ❑ Six or more residential units, ❑ Recreational vehicle parks.
City/State /ZIP: ---1-1, + 'w vl / ❑ Hazardous locations. �� ( �� } ❑ health -care facilities. ❑ Supply voltage for more than
600 volts nominal.
Suite/bldg. /apt. no.: Project name: Op, i IQ Service or feeder 600 amps or more.
�+ t '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 les 168 - 4
S „ lLtfh'� ► IE
Tax map /parcel no.: Ea. add'1500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION . OF WORK (with above sq. ft.)
Limited energy, multi- family 75.00 2
a G a G ` [ 6! ' � o. -1h.10 N 1 residential (with above sq. ft.)
Renewable Energy ❑ See Page 2
L 6. 7- -Ic---79L 5 ' y'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: RD, , a/ LT- 1_ O Pp 401 amps to 600 amps 200.34 2
Address: tD3(...\ 0 H 1 67 Nz� v0 601 amps to 1,000 amps 301.04 2
n Over 1,000 amps or volts 552.26 2
City/State /ZIP: /7 r [ \ c-1 Temporary services or feeders installation, alteration, and /or
Phone: (5 ) ( .( '!_) Z 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, le• rent, or exchan e, a rding to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature's Date: 7 - 2 ) — 1_,. Branch circuits — new, alteration, or extension, l er panel
• • 15kAPPLICANT . , . • • . ❑ •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
. branch circuit 56.18 2
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 fo7 it 2
E - mail: Pump or irrigation circle 67.84 2
' CONTRACTOR • ,•, . ' ' . Sign or outline lighting 67.84 2
Business name: 060 / Fi, 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
City/State/ZIP: Additional inspection (1 hr min) 66.25/ hr
Investigation (1 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 Lie.: Electrical Lie.: Suprv. Lie.: specifically listed (%2 hr min)
'ELECTRICAL PERMIT •FEES
Suprv. Electrician signature, required: Subtotal: 6)7.0
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): g• / 4 1
Authorized signature:
Date: 7 � -) 3 TOTAL PERMIT FEE: 75. g
(�\ / t ) This permit application expires if a permit is not obtained within 180
Print name: y � days after it has been accepted as complete.
/` {� z` Jr • Number of inspections allowed per permit.
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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 1 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
>100 kva (fee in accordance with 552.26 2
OAR 918 - 309 -0040)
❑ 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
charged at an hourly (1 hr min) 66.25/ hr
Inspections for which no fee is 90.00/ hr
specifically listed (%z 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 days after it has been accepted as complete.
• Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ 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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