Permit CITY OF TIGARD ELECTRICAL PERMIT
at
a COMMUNITY DEVELOPMENT Permit#: ELC2014-00153
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/03/2014
T[ '�RD g Parcel: 2S102BB00826
Jurisdiction: Tigard
Site address: 10465 SW JOHNSON CT
Project: KELLEHER Subdivision: BROOKSIDE PARK NO.2 Lot: 2
Project Description: (1)branch circuit for replacing mast.
Contractor: OWNER Owner: KELLEHER, KATHRYN K
KATHRYN KELLEHER 10465 SW JOHNSON CT
10465 SW JOHNSON CT TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-913-8970 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 04/03/2014 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 04/03/2014 $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 Center. Those rul: are t fort in OAR
952-001-0010 through OAR 952-001-0090. You may obtain- .• • - _ • - t questions to OUNC by calling 503 32.19: or 1.800.
eIssued 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 1 1/H (Ill 11 l 1 �1 11.1 1
i`11 Received
111 City of Tigard w
Date/By: Z `r Permit No.: L( (27,_l)Uls3
al 13125 SW Hall Blvd.,Tig• . •8' Plan Review" C
Phone: 503.718.2439 Fax. t .598.1960 Date/By: Other Permit:
Inspection Line: 503.639.4175 Q J,\ Date Ready/By: ]aria: See Page 2 for
J Notified/Method: 7. Supplemental Information
Internet: www.tigard-or.gov WI /1 �
OF ``c` PLAN REVIEW
❑New construction -Additior> ak ]e >�16M Please check all that apply(submit a sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: left it a1 where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUC It1Pt 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 Sfl'E 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: ` Q S.$A) f� �/��� Six or or o more residential occupancy.
J ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: 7774 4 r V k_ q 7 2.2-3 Cab( ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: U Project nam /, , ❑Service or feeder 600 amps or more.
f/ t—(— 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
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: . '
Limited energy,residential
75.00 2
- DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family
75.00 2 121/'d? Se ._4 J ee eye. 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 2
r ^ 201 amps to 400 amps 133.56 2
Name: r,( `� I�-Q Q I--e I�\ 401 amps to 600 amps 200.34 2
Address: ` \ i v W J W 1 (4 Vi 5S-6\ 1- 601 amps to 1,000 amps 301.04 2
City/State/ZIP: CS I c
` Over 1,000 amps or volts 552.26 2
Y Gt rC V� i ( Z�- 3 Temporary services or feeders installation,alteration,and/or
( Z) p / z �j q 6 ( ) relocation
Phone: '�d" ( O Fax:
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-nt, •r:xchange,Tor ding to SS 447.449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: I /(Q ��"C t �t�ate: — �/� Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
❑ APPL -• I ❑ CONTACT PERSON
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 / �/
branch circuit 1 56.18�1P, a: 2
Address: Each add'l 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 Signor 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(%hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: /t/K
Print name: Date: Plan review(25%of permit fee): -
State surcharge(12%of permit fee): b, y
Authorized signature: TOTAL PERMIT FEE: /
This permit application expires if a permit is not obtain d it in 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\Building1Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-461S1(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. 1 Fee I Total l *
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
ElAlarm 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
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) 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
El HVAC
El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
El 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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