Permit n CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2015-00781
T WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/29/2015
Parcel: 25101 BC01801
Jurisdiction: Tigard
Site address: 8365 SW HUNZIKER RD
Project: MILLER Subdivision: TIGARDIA TERRACE Lot: 4
Project Description: Replacing panel and(3)branch circuits.
Contractor: PORTLAND INDUSTRIAL SERVICES INC Owner: MILLER, LORI M
7715 NE 21ST AVE 8365 SW HUNZIKER RD
PORTLAND, OR 97211 TIGARD, OR 97223
PHONE: 503-208-3840 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 09/29/2015 $100.70
Specifics: amps or less
3 crt Branch Circuits w/Purchase 09/29/2015 $22.26
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 09/29/2015 $14.76
Electrical
Typo of Const:
Occupancy Grp:
Total $137.72
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 952-001-0090. You ma obtain a••py oft - es or direct questions to OUNC by calling 503.232.1•' or 1.800.33 .2344.
Issued By: 411.r_.„— - - • •ttee 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 Application FOR OFFICE USE ONL1
Received
.
City of Tigard ` e° Q
t5 f g �1V Date/B : fifl
UPI
• 13125 SW Hall Blvd.,Tigard,OR 97223.^ V
Phone: 503.718.2439 Fax: 503.5 Related Permit#:
inspection Line: 503.639.4175 Q 015 Ready Date/By: 65 See Page 2 for
TIGARD Internet: www.tigard-or.gov � 1 V Notified/Method: �j Supplemental Information
TYPE OF WORK rrl C�eON PLAN REVIEW
❑N construction [t Addition/alters 1 'r Vs, Please cheek all that apply(submit 2 sets of plans w/items checked):
❑New
ucons Demolition ❑Other: t���� ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
[W 1-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
Job#: Job Site address: J- �/ n ❑Addition of new motor load of system.
83b „5 w 4v a 2l Cede ntel 100HP or more. ❑"A., ..E„ ..1.2....1 t„
City/State/ZIP: ,� ❑Six or more residential units. occupancy.
L /9a? D" ❑ihealth-care facilities. ❑Recreational vehicle parks.
J /�),/1t I- ❑I lazardous locations. ❑Supply voltage for more than
Suite/bldg./apt.#: Project name: + f ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Q12. I Each I Total I
New 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 2
(with above sq.ft.) 75.00
a/Ve i rt-,/ cerrle,.,f Cvt<<4 (3) �irr-44 /.73. Limited energy,multi-family
residential(with above sq.ti.) 75.00
Renewable Energy ❑ See Page 2
yr PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: i a iti / ' )///tom 200 amps or less 1 100.70 M6,-7 9 2
Address: 8 3 Cy 5 S ,0.4 Z i,r6� Ad/ 201 amps to 400 amps 133.56 2
� n 401 amps to 600 amps 200.34 2
City/State/ZIP: ��4 ,44..) l eX 601 amps to 1,000 amps 301.04 2
Phone:(513 ) 1 944 _.s /D"7 Fax:( ) Over 1.000 amps or volts 552.26 2
C Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that 1 own which is not 200 amps or less 59.36 1
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
❑ 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
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2.
56
branch circuit 7�
City/State/ZIP: Each add'l branch circuit 3 7.42 alt+ 2
Miscellaneous(service or feeder not included) _
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: (rou) Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy' 13 See Page 2 2
Address: -77/5— ,.J, �/ S? panel,alteration,or extension.
�� p Each additional inspection over allowable in any of the above
City/State/ZIP:
Po �'C Additional inspection(I hr min) 66.25/hr
Phone:(563) -30y- V Fax:( ) Investigation(I hr min) 90.00/hr
Email: ,5;n7,0 f y shock)M L c._. Industrial plant(1 hr min) 78.18/hr
�( �� /l7 /G C O 1''t Inspections for which no fee is
CCB Lie.: )DD yf+ Electrical Lie.:G no I Suprv.Lic.:3 8'S3 f specifically listed(!!hr min) 90.00/hr
Suprv. Electrician si ,erequired- � ��' e41..5.---- tOtt`I(o ELECTRICAL PERMIT ubtotal: I J,„},q(,,
Print name: S-7211/6, L Make; Date:/0_ )r,1 j ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): ' p/. .7
Authorized signature:
TOTAL PERMIT FEE: /37 7,Z
This permit application expires if a permit is not o tained within 180
Print name: Date: days after it has been accepted as complete.
" Number of inspections allowed per permit.
1:-Building Tennits'ELC_PermitApp_ELR_ERE.doc Rev 06,17 2015 440-4615Th I1'05/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
s... Description I Qt.. I Each I Total
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 2
❑ 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
with OAR 918-309-0040) 552.26
I I 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:
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
sped licall∎ listed I'_hr min)
COMMERCIAL WORK ONLY: PERMIT FEES
Subto
Fee for each commercial system:. $75.00 allows al(Enter t tt Page I):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
n HVAC
Instrumentation
I I Intercom and Paging Systems
[ I Landscape Irrigation Control*
I I Medical
Nurse Calls
Outdoor Landscape Lighting*
[J Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:Building Permits ELC_PermaApp_ELR_ERE.doc Rev 06/17/2015
A