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Permit
CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2013 -00411 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/23/2013 Parcel: 1 S125DB06100 Jurisdiction: Tigard Site address: 7100 SW SHADY LN Project: Reid Subdivision: SHADY DELL NO.2 Lot: 34 Project Description: (1) branch circuit for fire place insert Contractor: OWNER Owner: REID, RAYMOND J & CECELIA A TRUSTEES 7100 SW SHADY LN PORTLAND, OR 97223 PHONE: PHONE: 503 - 244 -4291 FAX: FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 07/23/2013 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 07/23/2013 $6.74 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $62.92 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 accordance with 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 9 -001- You ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: OWNER INSTALLATION ONLY The installation is being made n props own ich is not inte ed for sale, lease or rent. �/ / � y OWNER'S SIGNATURE. ` Date: 2 . 3 JG 1 Oif // 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 Application RECEIVE i'° Fc)R OF USE ONLY City of Tigard 3 Received 7/a 3/%3 „, Permit No.:EL/ /3 D) Y// 1111 q II I I / c.t t Date/By: 13125 SW Hall Blvd Tigard, OR 97223 Plan Review ' - .. Phone: 503.718.2439 Fax: 5 03. 598.1960 Date/By: Other Permit: CI OF TIGARD luris: ® See Page 2 for :Ili C, A R 0. Inspection Line: 503.639.4175 late Ready/By: g Internet: www.tigard or.gov BUILDING DIVISIO otified/Method: T/� Supplemental Information • . .. 'TYPE 'OF'�WORK 'PLAN REVIEW ' ❑ New construction pi 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 0 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 • 0 Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ", e'. , / w ' _ IOOHP or more. occupancy. Job no.: Job site address: 71mO .St .) (s 1�h76- ❑ Six or more residential units. ❑ Recreational vehicle parks. O � y Z � ❑ Health -care facilities. ❑ Supply voltage for more than City /State /ZIP: P © �. t • �,,p� ` / El 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: 7,. D � � Y ) r 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. It) 75.00 2 Limited energy, multi- family 75.00 2 ■? I tzaia- d.) f PlAebr residential (with above sq. ft.) Renewable Energy ❑ See Page 2 ,/V 5Cj/t?.T Services or feeders installation, alteration, and/or relocation kii PROPERTY ,OWNER ❑ TENANT 200 amps or less 100.70 2 201 amps to 400 amps 133.56 2 Name: p E1 y� V /.....poi 401 amps to 600 amps 200.34 2 Address: 7 (�� le 601 amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 552.26 2 City/State /ZIP: l n� .T j , 0 9 7 2. Z3 Temporary services or feeders installation, alteration, and /or Phone: ( ? ) a L i q _ 3., f I " x: ( ) 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, re , or chan4e cording to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: Branch circuits — new, alteration, or extension, . er panel '0 APPLI 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/Blatt /ZIP: 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 . CONTRAC Sign or outline lighting 67.84 2 Business name: 0 � c — , 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 (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 Lic.: Electrical Lic.: Suprv. Lic.: specifically listed ('A hr min) - • ;ELECTRICAL PERMIT 'FEES • • Suprv. Electrician signature, required: Subtotal: Print name: Date: Plan review (25% of permit fee): State surcharge (12% of permit fee): 4, y Authorized signature: TOTAL PERMIT FEE: 607. ,. 02.— 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. I:\ Building\ Permits \ELC_PerrnitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(II /05 /COM/WEB 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 El 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 OAR 918- 309 -0040) 552.26 2 El 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 1 Inspections for which no fee is 90.00/ hr specifically listed (V5 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 El Audio and Stereo Systems days after it has been accepted as complete. • Number of inspections allowed per permit. El Boiler Controls ❑ Clock Systems El Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ 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 • 1:\ Building\ Permits \ELC_PennitApp_ELR_ERE.doc Rev 05/21/2013