Permit CITY OF TIGARD ELECTRICAL PERMIT
s. • COMMUNITY DEVELOPMENT Permit#: ELC2014-00413
T(G 1 RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/28/2014
Parcel: 2S102CB04300
Jurisdiction: Tigard
Site address: 13425 SW BARNUM DR
Project: HENDERSON Subdivision: BARNUM PARK Lot: 4
Project Description: Panel replacement.
Contractor: GENIE ELECTRIC CONSTRUCTION INC Owner: HENDERSON, CHRISTOPHER M& KATHE
8701 SE 156TH AVE 34021 SE STROUF ST
HAPPY VALLEY,OR 97086 SNOQUALMIE,WA 98065
PHONE: 503-762-9296 PHONE:
FAX: 503-762-9188
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 07/28/2014 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 07/28/2014 $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 done in accordance with approved plans. This permit will ex ipee 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 • ollow the rules adopter—by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through 2-001-0090. You ma o• a copy• - • •'.-ct• estions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued Bytom - — 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 A 1 s lic.. ,;tt i V � FOR OFFICE USE ONLY
• y A
City of Tigard rt% Received
III q 1. ` Date/ e .�. �f/ _
• 13125 SW Hall Blvd.,Tigard,OR 97223 ia ` Plan Review
■ Phone: 503.718.2439 Fax: 503.598.l - ,�Q►�v Date/B : Related Permit#:
Inspection Line: 503.639.4175 `� '`� i��`Sl0 Ready Date/By: BI See Page 2 for
t I�i,�I:I Internet www.tigazd-ocgov V 1 r
Notified/Method: �t_ Supplemental Information
TYPE OF W I . PLAN REVIEW
❑New construction A-Addition/alter I n/replacement Please check all that apply(submit sets of plans w/items checked):
❑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.
ja-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
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
/3 i.t❑Addition of new motor load of system.
Job#: I Job site address: l Li Zr S�- / 9/ 1(�a2/1.--TOOHP or more. ❑"A","E","1-z","t-3",
City/State/ZIP: 4 Q 2.2 ❑Six or more residential units. occupancy.
(( °` GY 7 ` L ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: 1 Project name: ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. 1 Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: 1 Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
-
Ea.add'1500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
/�in - fit- (with above sq.ft.) 75.00 2
h��CQ�`�-d Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation_ D
Name: 200 amps or less ( 100.70 (eel '
Address:
201 amps to 400 amps t 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) 1 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
Branch circuits-new,alteration,or extension,per panel
❑ APPLICANT r .CONTACT PERSON A.Fee for branch circuits with
Business name: e,'-e t .-e_./ c --/ co",5 ii-- 4)/4 C._ above service or feeder fee,
7.42 2
each branch circuit
Contact name: ‘--e"2v y wlf(- fe B.Fee for branch circuits without
Address: ? of service or feeder fee,first
Cj et)" v� branch circuit 56.18 2
City/State/ZIP: /4.4,,///1 G L(Le 40. 1e 170'4 6 Each add'I branch circuit 7.42 2
n Miscellaneous(service or feeder not included)
Phone:(605 7 6 z 47 Z 6 1 Fax: :(19"0 3) 26, 2— / 8 p' Each manufactured or modular 67.84 2
A r dwelling,service and/or feeder
Email: 6-e /e{/,� ,e 1' �- 7 C,1 5f e ic-re f Reconnect only 67.84 2
COCTOR Pump or irrigation circle 67.84 2
Business name: 6„P 'EL' l-l.Li�/'t Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: 8 1 f r5---6 .- panel,alteration,or extension. g
City/State/ZIP: //V Each additional inspection over allowable in any of the above
Til/e� G.cy /A)..0 Additional inspection(I hr min) 66.25/hr
Phone:(9)3) '7 6 Z C `46 I Fax.(5-3) 76 2--47/p tP Investigation(I hr min) 66.25/hr
/' Industrial plant(1 hr min) 78.18/hr
Email: S.QA(!-P--et 0 co-7 C q 5/4 t` ILle /
37 Inspections for which no fee is 90.00/hr
CCB Lie.: 46 G 3 9 1 Electrical Lie.: 3 if Gi2IJLuprv.Lie.: 4/5-3 3 6 5
specifically listed(%z hr min)
3 ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: �Z Subtotal: (0 0
Print name: 4 t.,E,,,bi Rv Date: 7/' _ //,‘ ❑Plan Review Required(25%of permit fee): (i
State surcharge(12%of permit fee):
Authorized signature: 1 TOTAL PERMIT FEE: f t Z.�
Print name: L t� This permit application expires if a permit is not obtained within 180
Le�j�j0 �`��f� Date: / days after it has been accepted as complete.
/ • Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 440-4615T(I l/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
Description I Qty. I Each Total I '
Fee for all residential systems combined: $75.00 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
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2•
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040) _
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over25 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 66.25/hr 1
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(/hr min)
COMMERCIAL WORK ONLY: PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
y ' Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ 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
I\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014