Permit u CITY OF TIGARD ELECTRICAL PERMIT
1111- C ' COMMUNITY DEVELOPMENT Permit#: ELC2013 00669
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/06/2013
Parcel: 1 S135DB02900
Jurisdiction: Tigard
Site address: 11515 SW 91ST AVE
Project: Hampton Subdivision: CHARBEN Lot: 12
Project Description: (2)branch circuits for bath remodel
Contractor: SAM HARDING INC Owner: HAMPTON, KENNETH B&
19988 SW GASSNER RD KNOLL, LAURA D
BEAVERTON, OR 97007 11515 SW 91ST AVE
TIGARD,OR 97223
PHONE: 503-780-6224 PHONE:
FAX: 503-356-9729
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 11/06/2013 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 11/06/2013 $7.63
Type of Use: SF 1 Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 a • -- .= 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. . - NTION: Orego law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-00 -0010 thro gh OAR 952-•0 •I'. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987• 1.800.332.2344./
r -
.
Is-uedBy: —��/A•4/i Permittee Signature: MIL. ' .,-< <-
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' /`_ �5t /fir /- 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 Applicati i EC IV _ . . . FOR_OFFIC .tJSI oNt.y
City of Tigard NOV 6 2013 Received
Date/By: / I, '3 Permit Permit No.: t-G C 5-‘5,0 ,g
IN 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C : Phone: 503.718.2439 Fax: 503.59 Date/By: Other Permit:
Inspection Line: 503.639.4175 OF TIGARD Date Ready/By: Juris: HI See Page 2 for
'I'I C A h l� Internet: www.ti g ar d org ov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
•
❑New construction G�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 0 Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
l-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","I-3",
Job no.: Job site address: /,' p
I OOHP or more. occupancy.
_ _ `/ � !i r 0 Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: -77 714 i 7 D,,..../ 9 77 , ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: N(r4..tr 0 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: Lot no.: 1,000 sq.ft.or less 168.54 4
Tax map/parcel no.: Ea.add'I 500 sq.ft.or portion 33.92 1
Limited energy,residential 75.00 2
'DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family
residential(with above sq.ft.) 75.00 — 2
Renewable Energy ❑ See Page 2
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: Jt� 9 i4} 2
401 amps to 600 amps 200.34 2
Address: /i/j/ ' GJ(#(./ 9/5 7 ,4 601 amps to 1,000 amps 301.04 _ 2
Over 1,000 snips or volts 552.26 2
City/State/ZIP: '`%t7,4�j� 6i-e, 97ZZ3 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
KAPPLICANT I , ❑ CONTACT,PERSON A.Fee for branch circuits with
above service or feeder fee,
Business name: K;4,,z i 1� hu�'
each branch circuit
7.42 2
B.Fee for branch circuits without
Contact name: '"7 2- 1--/Le,)`A fc� service or feeder fee,first / 56.18 i 2
branch circuit C�r �
Address: /7910 SJ7 ;0VS.t}17L . 7 Each add'I branch circuit f 7.42 7,4--z. 2
City/State/ZIP: —6Ezi� � / Miscellaneous(service or feeder nit included)
g 7�� Each manufactured or modular 67.84 2
Phone:(�,/��) �j�� Fax: : ) dwelling,service and/or feeder
"'� 7W��ZZ� 3 ` 9 7Z� Reconnect only 67.84 2
E-mail: �,yy1F/,g,ZZye,L.:-.2/ .J7 GM"R.., Co)fit Pump or irrigation circle 67.84 2
. CONTRACTOR CJ Sign or outline lighting 67.84 2
Business name: , j-4/2Allt..16--7 /A_/ Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: /G461 s(,C./ 6.;4<Si,Ei 2� Each additional inspection over allowable in any of the above
City/State/ZIP: �L^ Additional inspection(1 hr min) 66.25/hr
F.eI�1 verav,t'l or _ 87037 Investigation(I hr min) 66.25/hr
Phone:(5v3) ?- J 6 z Fax:('3) .—QlZ e7 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: Q''Qi/,(�J, Electrical Lie.: i, —f.9�Suprv.Lie.: 57735 specifically listed(%:hr min)
CC//�� ��CCJJ/f ��� ELECTRICAL,PERMIT FEES
Suprv.Electrician signatiSP ��tgired:l�a� Subtotal: to 5 too }
Print name: [� Date: _/ Plan review(25%of permit fee): �
���b t �Di�67 / `� /� State surcharge(12%of permit fee): 7-(' __
Authorized signature: /7T� TOTAL PERMIT FEE: 71 •a 3
!r This permit application expires if a permit is not obtained within 180
Print name:��� /../4 -.46/)...)(--7 Date:/�- -/3 days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\Build ing\Permiis ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-46I5T(1 I/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 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 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(!4 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
❑ Audio and Stereo Systems days after it has been accepted as complete.
" Number of inspections allowed per permit.
❑ Boiler Controls
❑ 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
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013