Permit IN - 4 CITY OF TIGARD ELECTRICAL PERMIT
tx : COMMUNITY DEVELOPMENT Permit#: ELC2013-00531
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/09/2013
Parcel: 2S103BD02600
Jurisdiction: Tigard
Site address: 11900 SW CARMEN ST
Project: Foley Subdivision: CARMEN PARK Lot: 5
Project Description: Replacement of service panel
Contractor: OWNER Owner: FOLEY, ROBIN L
ROBIN L FOLEY 11900 SW CARMEN ST
11900 SW CARMEN ST TIGARD, OR 97223
TIGARD,OR 97223
PHONE: 503-998-5809
PHONE: 503-998-5809
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 09/09/2013 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 09/09/2013 $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_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 donp'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 re. • - you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952101-0010 through OAR 952-001-!r90. Yo r-y obtain a copy of the rules or direct questions to OUNC by calling 503.232.19;or 1.800.332.2344. /
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Issd By: �. Permittee Signature: `ALL i
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OWNER INSTALLATION ONLY
The installation is being made on property I o hich is not intended for sale,lease or rent.
OWNER'S SIGNATURE d� 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 A licatio CEpED - FOR OFFICE USE ONLY
City of Tigard A� tee/ ? 9 i3 Mil Permit No.:a /i4 -_ 53
° 13125 SW Hall Blvd.,Tigard,OR 97223,r.D 9 Q 3 Plan Review
_ ` Phone: 503.718.2439 Fax: 503.598.1940'L-! 2 Date/B Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov CITY OFTIGARD Notified/Method: Supplemental Information
TYPE OF WADING 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 ISO volts or ❑Floating buildings.
• less to ground,or exceeds 14,000 ❑Commercial-use agricultural
N 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
El Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","I-2","I-3",
Job no.: Job site address: 11900 SW Carmen St IOOHP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97223 .. ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: Foley house ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 121 st and Walnut St,Tigard Description I Qtr. I Fee. I Total I •
New residential single-or multi-family dwelling unit.
_ _ Includes attached garage.
Subdivision:Carmen Park Lot no.:5 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.:655/C/4 '
Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family I 75.00 2
Replacement of Push-O-Matic breaker Box with new Main Breaker box residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
. ® PROPERTY OWNER • I ❑ TENANT 200 amps or less 100.70 /00.70 2
201 amps to 400 amps 133.56 2
Name:Robin L Foley 401 amps to 600 amps 200.34 2
Address: 11900 SW Carmen St 601 amps to 1;000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:Tigard,OR 97223 Temporary services or feeders installation,alteration,and/or
Phone:(503)998-5809 Fax:( ) relocation
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200 amps or less 59.36 I
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,o� hange,accordin• to O RS 447,449,670,and 701.
4`►/ ; 9/9 401 amps to 599 amps 168.54 2
Owner signaturd: lr�A Date: // Branch circuits—new,alteration,or extension,p_er 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 56.18 2
branch circuit
Address: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
Phone:( ) Fax: :( ) dwelling,service and/or feeder
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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(I hr min) 66.25/hr
City/State/ZIP: Investigation(I hr min) 66.25/hr
Phone:( ) Fax:( ) Industrial plant(I hr min) 78.18/hr
- Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lie.: Suprv. Lie.: specifically listed(%hr min) - ._
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
Subtotal: /�• 70
Print name: Date: Plan review(25%of permit fee):
-
State surcharge(12%of permit fee): /o/-og'
Authorized signature: TOTAL PERMIT FEE: //A, 7g
This permit application expires if a permit is not obtained within ISO
Print name: Date: • days after it has been accepted as complete.
• 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 14iY- I Fee 1 Total I •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 13156 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
El Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with
55
El Heating,Ventilation and Air Conditioning
OAR 918-309-0040) 2.26 2
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(I hr min) 66.25/hr
Inspections for which no fee is
90.00/hr
specifically listed(V2 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
ElAudio 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
El Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
El 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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