Permit CITY OF TIGARD ELECTRICAL PERMIT
.....
1 it
COMMUNITY DEVELOPMENT Per
COMMUNITY ELC2015-00055
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/29/2015
TIGARD Parcel: 2S 111 DB06100
Jurisdiction: Tigard
Site address: 15205 SW ALDERBROOK CT
Project: Fox Subdivision: SUMMERFIELD NO.7 Lot: 399
Project Description: Panel change.
Contractor: ELECTRICAL INNOVATIONS Owner: FOX, JERRY L& NORMA J
16453 SE 232ND DR 351 ANCORA DR S
DAMASCUS, OR 97089 LITCHFIELD, AZ 85340
PHONE: 503-358-6989 PHONE:
FAX: 877-718-02810
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 01/29/2015 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 01/29/2015 $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 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 rules are set forth in OAR
952-001-0010 through OAR 952-0W-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 1.800.332.234444.
G ��
Issued By: ��/ e rt� Permittee Signature: � /��il
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 Applicatio CENED FOR OFFICE USE ON1.1
City of Tigard ������ Receives �/ s�
13125 SW Hall Blvd.,Tigard,OR 9722 2015 Plan`Review
/ �..ar Permit 14° C //.J D10O
I Phone: 503.718.2439 Fax: 503.5987& Date/By: Other Permit:
TIC,A R Il Inspection Line: 503.639.4175 TIGARp Date Ready/By: 3�ris. ® See Page 2 for
Internet: www.tigard-or.gov /+`'1� OF J,v`slowt Notified/Method: Supplemental Information
TYPE J PLAN REVIEW
❑New construction `Lit,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.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
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","1-2","1-3",
Job n0.: Job site address: 100HP or more occupancy.
r 152 0 S �i.J � '�� b ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP.f I`',V. 0 /"--t- ❑Health-care facilities. ❑Supply voltage for more than
4 G• ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: I Project name: ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. 1 Total 1
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
(2C.tV e / CN41, residential(with above sq.ft.)
Renewable Energy I 0_See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER I ❑ TENANT 200 amps or less 1 100.70 /CO 7—e 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 1 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 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: service or feeder fee,first
branch circuit 56.18 2
Address: Each add'I 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 Sign or outline lighting 67.84 2
Business name:E/rd-1�," - I y i-V\ovi t.1- O _rvv tom, Signal alteration,or limited-energy See
' panel,alteration,or extension. Page 2 2
Address: /, L f 5'? sa- 3.t/lc p?„,„..... Each additional inspection over allowable in any of the above
ty �7 /5 Lt�S/ O 2 5 70,j Investigation inspection(1 mi(1 hr min) I I 66.25/hr
City/State/ZIP: J
Invegat (I hr min) 66.25/hr
Phone:(5v3 35 5 'r F Industrial plant(1 hr min) 78.18/hr
( !q, 'CJ Inspections for which no fee is
CCB Lic.:daz,/2.. Electrical Lic.�6 p ! Suprv.Lic.: 3oZ( 5 specifically listed(/hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,require ��� G�� Subtotal: j 00 7..Y— _
Print namtY�r / `L 45 Date: / —��—/j Plan review(25%of permit fee):
• •L State surcharge(12%of permit fee): 12,
Authorized signatur : TOTAL PERMIT FEE: i 'z
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.
t\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440.4615T(I 1/05/COM/WEB