Permit CITY OF TIGARD ELECTRICAL PERMIT
1111111 COMMUNITY DEVELOPMENT Permit #: ELC2013 -00717
Ti Ca A R T3 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/16/2013
Parcel: 1 S134DA05300
Jurisdiction: Tigard
Site address: 11252 SW 105TH PL
Project: Pfeifer Subdivision: NODAK Lot: 1
Project Description: (8) branch circuits for kitchen remodel
Contractor: OWNER Owner: STEVE PFEIFER
STEVE PFEIFER PO BOX 641
PO BOX 641 CANBY, OR 97013
CANBY, OR 97013
PHONE: 503 - 803 -2689 PHONE: 503 - 803 -2689
FAX:
FEES
Quantity Description Date Amount
8 crt Branch Circuits wo /Purchase 12/16/2013 $108.12
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/16/2013 $12.97
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $121.09
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 Ce , • - les are set forth in OAR
952 - 001 -0010 through OAR 952- 001 -0090. You may obtain a copy - • - - `rect questions to OUNC by calling 503.232,r1f 1.800. 34
� A
Issued By: ���`_` Permittee Signature: ���• � � . .
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
City of Tigard
III Recei ,_,1 , n q _
Date /By: -1 'r/ r i ,,L_,, Permit No.: Ez.(.- OW /��7/
13125 SW Hall Blvd. Tigard, OR 97223 Plan Review
' . Phone: 503.718.2439 Fax: 503.598.1960 :.� DateBy: Other Permit:
I I I: l r Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov V I \ ' Notified/Method: Supplemental Information
TYPE OF O C c , 3 \1 - •,V, PLAN REVIEW
❑ New construction JaAddition /alterationffeplacement 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: ` t ' where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUc 1 .» exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 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 ", "l -2 ", "l -3 ",
Job no.: Job site address: //G5 Sw / f {^ ,( IV/ 100HP or more. occupancy.
❑ d J
0 or more residential units. Recreational vehicle parks.
City/State /ZIP: O 6 9 74123 0 Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: filira,„__ ❑ Service or feeder 600 amps or more.
�/ FEE SCHEDULE
Cross street/directions to job site: Nfo n�� Description I Qty. I Fee. I Total
�/ Y 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 l
Limited energy, residential 75.00 2
DESCRIPTION CIF WORK (with above sq. ft.)
i J Limited energy, multi- family AidiAl of f rAib Ki d ; Cif``A� �- residential (with above sq. ft.) 75.00 2
/�yye/s��� Q a / ) Renewable Energy ❑ See Page 2
6:- S d, cy �
st 0`7 v-7, Z /! eel fri i Lei k s Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER • ❑ TENANT 200 amps or less 100.70 2
�' c
201 amps to 600 amps 133.56 2
Name: ¢ji 2
401 amps to 600 amps 200.34 2
Address: /42S.2 St...) /O h /j 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: f/ Q 2 ,0 OE 97,223 Temporary services or feeders installation, alteration, and /or
p relocation
Phone: () a 68 Fax: ( ) 200 amps or less 59.36 1
Owner installation: This ins • Ilation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, / - - • - - • .r cording to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 - 2
Owner signature: _� ..- —!` �- Date: /p7 /_3 Branch circuits - new, alteration, or extension, per 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: S/ Xi:2...e- service or feeder fee, first
/ 56.18 54) • S 2
branch circuit
Address: d 13-,,x_ 13-,,x_ / 16/ Each add'l branch circuit 7 7.42 SS t ,95/ 2
i / r
City/State /ZIP: >/ �j; / O £ (f� 97O 23 Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
Phone: O Fax:
( 693) at °Z ( ) dwelling, service and/or feeder
Reconnect only 67.84 2
E - mail: S u l t /24,1 / (o )t't Pump or irrigation circle 67.84 2
/ CONTRACTOR Sign or outline lighting 67.84 2
Business name: ej(,(J4. -- 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 (% hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: � g ,
Subtotal: /2
Print name: Date: Plan review (25% of permit fee): `—
State surcharge (12% of permit fee): /a .97
Authorized signature: TOTAL PERMIT FEE: /. J Dy
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.
1:\ Building\ Permits \ELC_PermitApp_ELR_ERE.doc Rev 05/21 /2013 440- 4615T(1I /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 Pee I Total 1 •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
El 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
El 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 (1 hr min) 6625/ 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
El Audio 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*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: \ Building\ Permits \ELC_PermitApp_ELR_ERE.duc Rev 05/21/2013