Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2014-00646
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/12/2014
TIGARD 9 Parcel: 2S110AD90007
Jurisdiction: Tigard
Site address: 14832 SW 109TH AVE
Project: Canterbury Woods Condominiums Subdivision: CANTERBURY WOODS CONDO Lot: 7
Project Description: Reconnect only.
Contractor: Owner: SQUIRES, BARBARA
14832 SW 109TH AVE
TIGARD, OR 97224
PHONE
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 11/12/2014 $67.84
Specifics:, 1 ea 12%State Surcharge- 11/12/2014 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 -nuance, or if work is suspended for more the 180
days. ATTENTION: Or=•on law requires you to follow the rules adopted by the Oregon Utility .•tifica.. • Center. Those rules are set forth in OAR
952-001-0010 through• ' 9�1-0090. You may obtain a copy of the rules or direct questions to OUNC by - ng 503.. ='0.332.2344.
Issued By: 1-4/11111////. t - Permittee Signatur _■
OWNER INSTALLATION ONLY -J
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.
RECEIVED
Electrical Permit Application FOR OFFICE USE ONLY• City of Tigard NOV 15 2014 Datt1`'ed ermitNo e/, /
13125,SW Hall Blvd.,Tigard,OR 9722.3N
7223 Pin Review
y C�ao/ oO��Jlo
I Phone: 503.718.2439 Fax: 503.59tt 1 f 1"OF TIGARD Date/By: Other Permit:
T I G A It D Inspection Line: 503.639.4175
BUILDING DIVISION Date Ready/By: Iar ® See Page 2 for
Internet: www.tigard-or.gov J Notified/Method: 7/, r-"" Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ 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 ❑Floating buildings.
1-and 2-family dwelling Commercial/industrial less to ground,or exceeds 14,000 ❑Commercial-use agricultural
y g ❑ ❑Accessory building amps for all other installations. buildings.
Multi-family e fi- ❑Master builder 0 Other: amps
pump. buildings.
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.: Job site address: 14832 SW 109th Ave 100HP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97224 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qts. 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'l 500 sq.ft.or portion 33.92 I
Tax map/parcel no.: Limited energy,residential 75.00
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 7500
Gen.Electrical Inspection residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
CO PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name:Federal National Mortgage do Dan Flake Realty 401 amps to 600 amps 200.34 2
Address:5603 SW Hood Ave 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:Portland,OR 97239 Temporary services or feeders installation,alteration,and/or
Phone:(888)502-5098 Fax:( ) relocation
200 amps or less 59.36 I
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. •
401 amps to 599 amps 168.54
Owner signature: Date: Branch circuits—new,alteration,or ex tension,per panel
❑ APPLICANT I ® CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42
Business name:Dan Flake Realty each branch circuit
B.Fee for branch circuits without
Contact name:Dan Flake service or feeder fee,first 56.18
branch circuit
Address:5603 SW Hood Ave Each add'l branch circuit 7.42 2
City/State/ZIP:Portland,OR 97239 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(888)502-5098 Fax: :( ) dwelling,service and/or feeder
Reconnect only
/ 67.84 2
E-mail:bobby.valentino @or-reo.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or 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(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(t/2 hr min)
ELECTRICAL PERMIT FEE_S
Suprv.Electrician signature,required: Subtotal:
Print name: ..N .s A _ te., d, Date:`\ I .....,t, Plan review(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: 7.5". 9'f
.
This permit application expires if a permit is not obtained within 180
Print name: ate: 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(I I/05/COM/W'1.15
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
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to So kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
OAR 918-309-0040)
Heating, Ventilation and Air Conditioning
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: Electrical inspection 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('h 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
C\Building\Permits\IiI.C_PermitApp_ELR_I:Rfi.doc Rev 05/21/2011