Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC201300417
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/24/2013
Parcel: 25111 DD15200
Jurisdiction: Tigard
Site address: 8769 SW HAMLET ST
Project: Ford Subdivision: MILLMONT PARK Lot: 29
Project Description: (1) 200 amp panel for upgrade and small repairs.
Contractor: VANGUARD ELECTRIC INC. Owner: FORD, SYLVIA A
3800 MORRIS ST 8082 PONY FALLS CT
NEWBERG, OR 97132 REDMOND, OR 97756
PHONE: 503 - 537 -5006 PHONE:
FAX: 503 - 537 -5019
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/24/2013 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 07/24/2013 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports (Conditions)
This permit i • - •'ect 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 wit' 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. • TENTION: Oregon eq 'res ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 -0010 thr•ugh OAR 952-0W-009o. • ay obtain a cop of the rules or direct questions to OUNC by cal ' • : 13.232.1987 or 1.800.332. 4. ^
Issue. By: I� l a Permittee Sign.. re: 2— �� ; t t w/ �� �--
r
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 Far / % 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.
Mall or 'pr 0
Electrical Permit Application 1 II\ FOR OFFICE USE ()NIA
`� '
City of Tigard yM; ,, r `4' , Permit No.: ELC�D /3 —190 / 7
V 131 SW Hall Blvd., Tigard, OR 972 •t t 1,1716i07,,.,
: � 0 Phone: 503.718.2439 Fax: 503.598.1' t '-, • • , Older Permit:
1 . 1 C, F O Inspection Line: 503.639.4175 2 2 2013 Date Ready/By: 3uri I � ® See Page 2 for
Internet: www.tigard or.gov Notified/Method: 1 l7 Supplemental Information
TYPE OF WORiciNOF TIGARD PLAN •REVIEW
❑ New construction ,ErAddition/alterat Please check all that apply (submit l sets of plans w /items checked below):
V'�71 V ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATECORY OF "C exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
dwelling Commercial/industrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
and 2-family g ❑ ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 150 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION . ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", `I -3 ",
Job no.: A ctrn (et Job site address: 8 ► 6 1 CJW Hamlet 100HP
or more Recreational vehicle parks.
City/State /ZIP: D� q"] Z-Z El Healthcare facilities. ❑ Supply voltage for more than
'Nara ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 1,,VArn lei. / Z mf man ❑ 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: - I 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.)
M `U �/� r' Limited energy, multi - family 7500 2
' " n Q ,act W •�- small i rs residential (with above sq. ft.)
J Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and/or relocation
• - • 0 , PROPERTY OWNER I • ❑ TENANT • 200 amps or less I 100.70 /C 70 2
c G 201 amps to 400 amps 133.56 2
Name: J 1 t Vict • 1 r.d 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: ( ) I 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 ` aCONTACT PERSON A. Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: Vang uard EleG -ri G -�-4 . each branch circuit
B Fee for branch circuits without
Contact name: Ch r 16 a-- s tr w ' 4 e.., service or feeder fee, first 56.18 2
branch circuit
M
Address: 3 gOf' orris rs i-• Each add'I branch circuit 7.42 2
City/State /ZIP: 1 Miscellaneous (service or feeder not included)
�e I,V�r OR Q I3 2- Each manufactured or modular 67.84 2
Phone: (503) 637 Sac; I Fax: • ( y j' --. dwelling, service and/or feeder
Y �j Reconnect only 67.84 2
E -mail: van , tr d e I et 1 c, Qrna.1 I. c Pump or irrigation circle 67.84 2
CONTRA O( Sign or outline lighting 67.84 2
Business name: ' Signal circuit(s) or limited- energy See
Vah IdGtr Ele�trr G / '+" • C - panel, alteration, or extension. Page 2 2
Address: t3 D W M, b r r i S cS - Each additional inspection over allowable in any of the above
q- Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: N eu) • , O R ` L 132 Investigation (I hr min) 66.25/ hr
hone: so3 )53'! . C,', • I 'ke"Cei f) 1.5 - 7
2 )3i Industrial plant (1 hr min) 78.18 / hr
'L p � v Inspections for which no fee is 90.00 / hr
4 /13 /CCB Lic.: I b� I Electrical Lic .: b — I C I Suprv. Lic r DV 5 specifically listed ( hr min)
Suprv. Electric signature, required - ELECTRICAL PERMIT FEES a
Subtotal: !( . 7
Print name: r i St , • — n 4 i bate: " 6 13 Plan review (25% of permit fee):
I ' State surcharge (12% of permit fee): .,...• �,
Authorized signature TOTAL PERMIT FEE: a 710
�2Lr 'w t r b / � /
Print name: --k3 This permit application expires if a permit is not obtained within 180
.T � y1 , 5'I r QI1 Q G Date 7� �6 days after it has been accepted as complete.
J • Number of inspections allowed per permit.
L\ BuiIding\P erm its \ELC_PermitApp_ELR_ERE.doe Rev 0521/2013 440- 4615T(I1 /05 /COM/WEB