Permit 11111 p CITY OF TIGARD ELECTRICAL PERMIT
q
3 COMMUNITY DEVELOPMENT Permit#: ELC2015-00758
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/21/2015
Parcel: 2S104DA07900
Jurisdiction: Tigard
Site address: 13055 SW RAPTOR PL
Project: Bradley Subdivision: QUAIL HOLLOW-WEST Lot: 65
Project Description: Electrical reconnect only
Contractor: NOT REQUIRED Owner: GARY BRADLEY
5211 WEST SUNSET DR
LAKE OSWEGO, OR 97035
PHONE: PHONE: 503-502-2291
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 09/21/2015 $67.84
Specifics:
1 ea 12%State Surcharge- 09/21/2015 $8.14
Electrical
Type of Use: SF
Class of Work: OTR
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 ccordance • 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. TENTION: Oregon :w re. es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 1-0010 through OAR 952-0i 1 '90. Y.. ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.198 or 1.800.332.2344.
I sued By: �' Permittee Signature: /i ' '�
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 ONLi
City of Tigard ECE�VET� Received 9 Permit t;: ,/y-0Q.751
Date/B . 75
IN - 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
i. Phone: 503.718.2439 Fax: 503.598039 A 1 01 Date/B ; Related Permit N:
Inspection Line: 503.639.4175 JJ C r 21 Ready Date/B\ Juri,: 65 See Page 2 for
Ill�:%It I)
Internet: www.tigard-or.gov Notified/Meth,,) Supplemental Information
` t1 Y
TYPE 0 PLAN REVIEW
❑New construction ❑Additiot 7 a?'t��'1 1' 1. ')t' t i Please check all that apply(submit 2 sets of plans w/iteins checked):
❑ / ❑Service or feeder 400 amps or more ❑Building over three stories.
Demolition Other: �, ,C C
where the available fault current 0 Marinas and boatyards.
CATEGORY OF exceeds 10,000 amps at 150 volts or ❑Floating buildings.
gral-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14.000 ❑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
�+
0 Addition of new motor load of system.
Job#: Job site address:
3�'J 5 Ss.C) p
Ptor` I. 100HP or more. ❑ A E ,«t_2», 1-3
City/State/ZIP: -r' ;140,.-`I / C K 9 1 z' 3 D Six or more residential units. occupancy.
1 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: D 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 Qly. I Each I Total I .
Nevi residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential 75.00
(with above sq.ft.) -
Limited energy,multi-family 75.00
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
'PROPERTY OWNER ❑ TENANT Services or feeders installation,,alteration,and/or relocation
Name: C�r f► a 81 e „� 200 amps or less 100.70 '_
J 201 amps to 400 amps 133.56 2
Address: 5 2/1 w es cvt,tS L-H 1"..4✓ 401 amps to 600 amps 200.34 2
City/State/ZIP: [.ake ac,,,„ejta C e `! 703 S 601 amps to 1,000 amps 301.04 2
Phone:(5'03)c0.2-ZZ q % Fax:( e 3) 636--S 9 q 1 Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: 4 e die r 3 Q c_ei,K C&S'f'. ti e_ -)- relocation
Owner installation:This installation is being made on property that 1 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
amps to amps 168.54 2
401 am 599
Owner signature: Date: p
❑ APPLICANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) i Fax: :( ) Each manufactured or modular 67.84 2
Email: dwelling,service and/or feeder
Reconnect only ` 67.84 ( 7 gy 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: panel,alteration,or extension. g
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90,00/hr
CCB Lic.: Electrical Lie.: Suprv. Lic.: specifically listed('/hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
Subtotal: 6,7,g7e/
Print name: Date: D Plan Review Required(25%of permit fee): _ ------
State surcharge(12%of permit fee): 8 iq
TOTAL PERMIT FEE: 9
Authorized signature: 75 '
- r This permit application expires if a permit is not obtained within 180
Print name: t-G�7 y -7...7i ---- -- ----*- --------
a C i, Dat e: lJi_Z ) /....5 J days after it has been accepted as complete.
/ " Number of inspections allowed per permit.
I:Building Permits ELC_PermitApp_ELR_ERE.doc Rev 06:17/2 IS 440-4615T(II'051COM WI B
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Dcscript ion I Qty. 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
5.01 to 15 kva 133.56
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26
n Garage Door Opener* >100 kva(fee in accordance 552.26
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* 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:
I Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specilicall■ listed('_hr min)
COMMERCIAL WORK ONLY: ELECTRICAL 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
n 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
t:Building,Permits,ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015