Permit CITY OF TIGARD ELECTRICAL PERMIT
11 , COMMUNITY DEVELOPMENT Permit#: ELC2013-00504
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/22/2013
Parcel: 25111 CB01711
Jurisdiction: Tigard
Site address: 10125 SW HOODVIEW DR
Project: SESNON Subdivision: HOOD VIEW Lot: 10
Project Description: Grounding for water service replacement.
Contractor: OWNER Owner: SESNON, KAREN E&ROBERT H
10125 SW HOODVIEW
TIGARD,OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 08/22/2013 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/22/2013 $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 enter. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the direct questions to OUNC by calling 503.2 .1987 or 1.8 32.2344.
Issued By: � `� ���_ '-e Signature: a C�� „
11112.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' 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
FOR OFFICE USE ONLY
Received
• City of Tigard �� DateB : Permit No.: — — S
13125 SW Hall Blvd.,Tigard,0's.C'∎; Plan Review
• C Phone: 503.718.2439 Fax: 503'=1':. •60 �3 Other Permit:
do Date/By: aoJ3-odagS
Ins ection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
`fIGARD p
Internet: www.tigard-or.gov P� �C��G01 Notified/Method: • ra-Cp Supplemental Information
' TYPE OF W• i A��1 \` PLAN.REVIEW
❑New construction iKAddition/altera t• ?,,ti 'Cement Please check all that apply(submit 2 sets of plans w/items checked below):
B'� ❑Service or feeder 400 amps or more ❑Building over three stories.
El Demolition El 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
C] 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",
Job no.: Job site address: /,, '• , 100HP or more. occupancy.
Q 2� (4 �� / ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: .4.-.) O ci 2 7 ❑Ilealth-care facilities. ❑Supply voltage for more than
�i ❑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: N!"4O Description I Qty. I Fee. I Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 17) , 1,000 sq.ft.or less 168.54 4
' t Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.:
0 5) 44 2 .3'S Limited energy,residential
DESCRIPTION OF WORK ' (with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) I 75.00 2
Renewable Energy ❑ See Page 2
nn���� Services or feeders installation,alteration,and/or relocation
y�-PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: /4� ] css N c 401 amps to 600 amps 200.34 2
Address: /Cot t &4o 0,s 1:3 vi bit 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: 77&peLJ) OP-, 91 Zut Temporary services or feeders installation,alteration,and/or
Phone:(S (c)S-14 O). 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 exch e,according to ORS 447,449,6700,and 701. 401 amps to 599 amps 168.54 2
Owner signature. � c�(�n rn Date: e/ /J _Branch circuits-new,alteration,or extension,per panel
la APPLICANT ❑ 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: /��,(k_A service or feeder fee,first g
1
"' .�e '— branch circuit 56.18 s� I 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 2
E-mail: Pump or irrigation circle 67.84 2
,CONTRACTOR. Sign or outline lighting 67.84 2
Business name: 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(I 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(%z hr min)
!ELECTRICAL.PERMIT FEES •
Suprv.Electrician signature,required: Subtotal: , f
Print name: Date: Plan review(25%of permit fee): i
t j State surcharge(12%of permit fee): (D-7 Li
Authorized signs . SCS.-it TOTAL PERMIT FEE: (paZ. 9 2
<� p This permit application expires if a permit is not obtained within 180
Print name: aG s �� Date: 8-124 l� days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC_PernitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(I1/05/COM/WEB
Electrical Permit Application—City of Tigard ..
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
•
'RESIDENTIAL WORK•ONLY: •FEE SCHEDIl E •
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
>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 over25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
ElOther: 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 feeds' ' - 90.00/hr
specifically listed(V.hr min)
COMMERCIAL WORK ONLY: I '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 istnot obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
" Number of inspections allowed per permit.
❑ Boiler Controls . .
El 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 .` ,
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013
•
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical,mechanical,and plumbing permits.
Licensed architect and engineer applicants,exempt from licensing under ORS 701.010(7), need not
submit this statement.This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this horn eowner statement is true and accurate.
A) S'ESNo n)
Print N me of Permit Applicant
g/221/3
ignature of Permit Applicant Date
Permit#: 1/11 _ • Etc :./ -o'a
sik
Address: gj%-'
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Issued b Date: ie_ _ rr:
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This Copy for Permit Offices