Permit CITY OF TIGARD ELECTRICAL PERMIT
;71 t3 • COMMUNITY DEVELOPME Permit #: ELC2013 -00381
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/08/2013
Parcel: 2S 101 AA06400
Jurisdiction: Tigard
Site address: 12323 SW 66TH AVE
Project: Selectron Subdivision: WEST PORTLAND HEIGHTS Lot: 32
Project Description: (78) branch circuits for new TI and to rewire existing HVAC unit. Adding (2) low voltage systems for audio /stereo &
data telecommunications.
Contractor: CAMERON THOMAS LLC Owner: STONER, DAVID S
P.O. BOX 5324 338 SE SPOKANE ST
ALOHA, OR 97006 PORTLAND, OR 97202
PHONE: 503 - 704 -0049 PHONE: 503 - 597 -3303
FAX: 503 - 715 -0560
FEES
Quantity Description Date Amount
78 crt Branch Circuits wo /Purchase 07/08/2013 $627.52
Specifics: Service or Feeder
2 ea Signal circuit or Limited 07/08/2013 $150.00
Type of Use: COM Energy Panel
Class of Work: ALT 1 ea 12% State Surcharge - 07/08/2013 $93.30
Electrical
Type of Const:
Occupancy Grp:
Total $870.82
Required Items and Reports (Conditions)
This permit is iss - • - • 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 with appr• e• • ans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATT' TION: Oregon law e•uires you • follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 -001 -0 t-10 throu!h OAR 952-01 -009. Yo •twin a copy of the ru es or direct questions to OUNC by calling 503.232.198 1. 00.332.2344.
Issued Permittee Signature:
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: 7,4'5
LICENSE NO. 47740 zjS
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 ONLY
Applicati rENED FOR OFFICE USE
Tigard �� 1 Received / P i -t70
City of
Date/By: 7 / 3 ( (}� erm t No.: �J 3 3 v
q 13125 SW Hall Blvd., Tigard, OR 97223 g Z01
III Plan Review
' C Phone: 503.718.2439 Fax: 503.598.19thr Date/By! Other Permit: p A 3- DD /A/
.I. I Ci A R D Inspection Line: 503.639.4175 ^t•�/ OFTIG RD Date Ready/By: lung: El See Page 2 for
Internet: www.tigard- or.gov V11 1 lJ� rn Notified/Method: Supplemental Information
TYPE OF CM DIVISION PLAN REVIEW
❑ New construction 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 snips 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 ", "l -3 ",
Job no.: Job site address: l '2_ 323 �� ( (Q Six or or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: In (7iZ27 (J- C32 77.2., ❑ Health -care facilities. 0 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: D 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 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family
12 IN l C KU vc -- Vb — g
(Z1/v Ocr—F1 cEAt/p 1 aA: residential (with above sq. ft.) 75.00 2
� ,,�•, Renewable Energy ❑ See Page 2
' �( UG( t< CV V l 1 (S7I/VG IA-IA, oil r 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 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 I 56.18 so 1 p' 2
branch circuit
Address: Each add'I branch circuit 7 7 7.42 5 7) 3' f 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: Cp. E a T u 0r42,A,s Ll_C_ Signal circuit(s) or limited 2 See jj ��
panel, alteration, or extension. Page 2 l 2
Address: ?C 3Z 4 Each additional inspection over allowable in any of the above
Additional inspection (I hr min) 66.25/ hr
City/State /ZIP: f\ LoLtA. OV-- c) 7 0613 Investigation (1 hr min) 66.25/ hr
Phone: (5D3) 7o .. Oa f 9 Fax: (503) 7/3 OS jf,a Industrial plant (1 hr min) 78.18/ hr
Inspections for which no fee is 90.00 / hr
CCB Lic.: I.5 7 * 3 Electrical Lic.: 7 3 C - , C. Suprv. Lic.: 46 33 S specifically listed (% hr min)
7/r 505 1/, by /% d 3 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: — 7 - 7 7 ,� 2
Print name: 4-1) ))\.) ' Date: 7 �- `j- Plan review (25% of permit fee):
J State surcharge (12% of permit fee): 9, ' '
Authorized signature: TOTAL PERMIT FEE: 87 () , 82
Print name: Date: This permit application expires if a permit is not obtained within 180 ,At/
days after it has been accepted as complete. �r
" 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 I Qtr. 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
❑ 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 66.25/ hr
charged at an hourly (1 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
1 21 Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
fI 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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