Permit n CITY OF TIGARD ELECTRICAL PERMIT
111111 ID COMMUNITY DEVELOPMENT Permit#: ELC2013 00690
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/19/2013
Parcel: 1 S134CC00600
Jurisdiction: Tigard
Site address: 12175 SW MERESTONE CT
Project: Blazer Subdivision: MERESTONE Lot: 5
Project Description: (5)branch circuits for misc items,220 in garage,landscape lighting,misc plugs and lights
Contractor: OWNER Owner: BLAZER,JENNA STAR
JENNA BLAZER 12175 SW MERESTONE CT
12175 SW MERESTONE CT TIGARD,OR 97223
TIGARD, OR 97223
PHONE: 503-701-6973 PHONE: 503-701-6973
FAX:
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo/Purchase 11/19/2013 $85.86
Specifics: Service or Feeder
1 ea 12%State Surcharge- 11/19/2013 $10.30
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
Required Items and Reports(Conditions)
This permit is ' ed su•I- 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 with ap• •ved 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 law =:•fires •ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
•952- 1-0010 through OAR 952-00 '090. yo obtain a copy of the rules or direct questions to OUNC by calling 503.232. or 1.800.332.2344.
Is ued By: .� 1it�1i`I .`1 Permittee Signature: /`
OWNER INSTALLATION ONLY
The installation is being made on property I ich is not intended for sale,lease nt.
OWNER'S SIGNATURE t ■ Date: /�X 94
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 Applicat' FOR:OFFICEUSE-ONLY- -- -CI of Ti and Received / PermitNo.:`J g DateB :13125 SW Hall Blvd.,Tigard0 J ' CEVED 9 Plan Review
i p
Phone: 503.718.2439 Fax: 503.598. n Date/By: Other Permit:
Inspection Line: 503.639.4175 � 2013 Date Ready/By: Judo: El See Page 2 for
I l c'A h U
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
F TIGARD
TYPE 0 ^DIVISION PLAN REVIEW • •
❑New construction Addition/a t r on/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
❑ i-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.: I Job site address: (� IOOHP or more. occupancy.
2' 5 W Val eve S Q Ovs'e d- 0 Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: p ❑Health-care facilities. ❑Supply voltage for more than
Jq ✓a (b r— 91 ZZ 3 ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: I Project name: ❑Service or feeder 600 amps or more.
• FEE,SCHEDULE
Cross street/directions to job site: \ 2 \ t-,„....,A y , cA, C\•- 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 75.00 2
' DESCRIPTION OF WORK plc/ hoc,/Se / (3 ki (with above sq.ft.) .
/ �./ p� 41--..' Limited energy,multi-family 75.00 2
�d 01 C I`r G Li. r A✓ p e,..1�G1'Op✓ (v,mac, e /t S residential(with above sq.ft.)
�` t Renewable Energy I ❑ See Page 2
14 n/fr,c ,�p.✓ �k/ Add e G-r�4- 7''0 r- 2.20 /r1 Services or feeders installation,alteration,and/or relocation
f arct .-e 200 amps or less 100.70 2
P OPERTY OWNER I ❑ TENANT 9 S
201 amps to 400 amps 133.56 2
Name:j.e Y) fl r -Z\ ,(-- V `` 401 amps to 600 amps 200.34 2
Address: 1 Z\ , S� G✓T 601 amps to 1,000 amps 301.04 2
5 5w �z��
Over 1,000 amps or volts 552.26 2
City/State/ZIP: --C' 1 rj T1�, Z-2-3 Temporary services or feeders installation,alteration,and/or
Phone:(53 ) "7 1 - (7c7 3 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,leas- •r exchange,according to ORS 447,449,670,((and 7 401 amps to 599 amps 168.54 2—-
Owner signature: Date: 1 - 3 Branch circuits-new,alteration,or extension,per panel
• ❑ AP' •NT' . 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 1 /_
Contact name: service or feeder fee,first
56.18 5W' U 2
branch circuit
Address: Each add'I branch circuit '"1" 7.42 2
City/Blatt/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:( ) I 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: "-- (D(r) Al)e 2 -- 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
City/State/ZIP: Additional inspection(I hr min) 66.25/hr
Investigation(I hr min) 66.25/hr
Phone:( ) I Fax:( ) Industrial plant(1 hr min) 78.18/hr ,
Inspections for which no fee is
CCB Lie.: I Electrical Lie.: I Suprv.Lie.: specifically hr
fically listed(%1 hr min)
ELECTRICAL',PERMIT FEES
Suprv.Electrician signature,required: Subtotal: g; ' "a
Print name: Date: Plan review(25%of permit fee):
State surcharge(12%of permit fee): Q•
Authorized signature: TOTAL PERMIT FEE: �b e /4
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_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(11/05/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
El 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 • OAR918-309-0040)
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(1 hr min) 66.25/hr 1
Inspections for which no fee is 90.00/hr
specifically listed(/2 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
•
El Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El 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
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