Permit a CITY OF TIGARD ELECTRICAL PERMIT
`'1 s ' COMMUNITY DEVELOPMENT Permit#: ELC2015-00030
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/20/2015
Parcel: 2S112CA11700
Jurisdiction: Tigard
Site address: 7867 SW ASHFORD ST
Project: Taylor Subdivision: RENAISSANCE WOODS Lot: 43
Project Description: Installation of(1)branch circuit for floor heat.
Contractor: GARY'S ELECTRIC CO LLC Owner: TAYLOR, PAUL S AND JOANNE C
1401 SW WALLULA DR 7867 SW ASHFORD ST
GRESHAM,OR 97080 TIGARD, OR 97224
PHONE: 503-465-8145 PHONE:
FAX: 503-465-8517
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 01/20/2015 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/20/2015 $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 foil• e rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtai •the rules or direct questions to OUNC by calling 50; /, .1987 or 1.880. . 344.
IDI yt/J
Issued By: .air--_,,...---- Permittee Signature: k'
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 ApplIca FOR OFFICE USE oil
City of Tigard EffillEgEMIIIII l'ermn No.: fl,C /e/s aon
• 13125 SW Hall Blvd.,Tigard,08241 0 20 5 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Dare/B : Other Permit:
TIGARD Inspection Line: 503.639.4175 h`,`r�. rt(,ARD Dale Ready/By: turis El See Page 2 for
Internet: www.tigard-or.go�Y,�k,, rI V IIV Notified/Method: Supplemental Information
1_._-- AtaptticalVISION PLAN REVIEW
Please check all that apply(submit 2 sets of plans vv/items checked below):
❑New construction Addition/alteration/replacement
❑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
11 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","I-2 "I-3",
Job no.: Job site address: 6, C `,) A S� '
■ IOOHP or more occupancy.
7�"� w , 1""'�1 v ❑Six or more residential units. ❑Recreational vehicle parks.
1r
City/State/ZIP: / 1 , C4 d r O ❑health-care facilities.
❑ 0 Supply voltage for more than
f laiardous 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 Qty. I Fee. I Total
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'1 500 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
T 75.00 2
nS 1( APP -ct( —(1-' l,Cgr Aett Renewable dnti residential
vesq.ft.) ❑ seePa
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) 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,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
❑ APPLICANT 1 ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
742
Business name: each branch circuit 2
B.Fee for branch circuits without `may
Contact name: service or feeder fee,first 1 56.18 ca„, `p 2
branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
Phone:( ) Fax: :( )
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: c{'Ys F/ f rl'C Co L( Signal circuit(s)or limited-energy ' See
( panel,alteration,or extension. Page 2 2
Address: 11i Q( 5 v) lAk(,10 k a r Each additional inspection over allowable in any of the above
City/State/ZIP: O ! ��g� Additional inspection(I hr min) 66.25/hr
�5 S�t Investigation(1 hr min) 66.25/hr
Phone:(S-CA) q L-S - V(4(4 Fax:(�d3 ) �t� '3 7 Industrial plant(I hr min) 78.18/hr
/ �w�S.7 inspections for which no fee is 90.00/hr
CC L;C� o3"t Electrical Lic.:C' /Q/O Suprv.Lie.: 4O S speciticallylisted('/,hrmin) _
Cy, Iy //��� ��
/a///4-, ELECTRICAL PERMIT FEES
Su rv. Electrician signature,required: G
Subtotal: ,i D
Print name: �� R9'1-fo n ( Date:34'l /(o Tp I s Plan review(25%of permit fee): �,(
State surcharge(12%of permit fee): b, 7�7
Authorized signature: `�1: ,(f� TOTAL PERMIT FEE: ,� 9.4-
j�_ p This permit application expires if a permit is not obtained within 180
Print name: G a 1 l� t'f 6 h Date: �fh /b �/ days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:1 Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-46151(1 1/OS/COM/WEB