Permit (38) CITY OF TIGARD ELECTRICAL PERMIT
II ` COMMUNITY DEVELOPMENT Permit#: ELC2017 00046
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/23/2017
-TA . ,4 R l a 9 Parcel: 2S111 DB00400
Jurisdiction: Tigard
Site address: 15260 SW ALDERBROOK DR
Project: Sutton Subdivision: SUMMERFIELD NO.8 Lot: 432
Project Description: Replace electrical panel
Contractor: CARTON ELECTRIC INC Owner: SUTTON,GREGORY S&PATRICIA REV
PO BOX 860 LIVING TRUST
AMITY, OR 97101 9227 EAST CHAMPAGNE DR
SUN LAKES,AZ 85248
PHONE: 503-435-1600 PHONE:
FAX: 503-835-0539
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 01/23/2017 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 01/23/2017 $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 i 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. TTENTION: Oreg law requires you to follow the rules adopted by the Oregon Utility Notification Center. hose rules are set forth in OAR
95 001-0010 through OAR 9 2-0 . ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19 Vr::' - .)-:44.
sued By: �� ���1-2_ iLL.4-4i� 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' - f �Et-1'! Date: SA�/�7
LICENSE NO. 50756
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 ONLY
City of Tigard Date/B :Received
f t�� Permit#: [��- 7/7- %4
ill • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.19 AN Date/B : Related Permit#:
� 2 3 2 017Juris:
Inspection Line: 503.639.4175 Ready Date/By: See Page 2 for
TIGARD Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY O I�.:lAdr...)
TYPE OStilti P G 1-Yostoro PLAN REVIEW
❑New construction g Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
Q. 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address/5 �,iuf 4w/-.y 100HP or more. ❑"A","E","1-2","1-3",
❑Six or more residential units. occupancy.
City/State/ZIP: 77-L<-7,1"....../.„) 9 7 2_7— ❑Health-care facilities.
0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. 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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
�� /'-/---j-/-""
(with above sq.ft.) 75.00 2
/v6.,i/ 2-. ifi ' J_ '/ J2,. >337/1/ --- Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
[PROPERTY OWNER 0 TENANT
Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: CO7 Slee—/ 200 amps or less ' 100.70 2
Address: /I 201 amps to 400 amps 133.56 2
/r4/�L- 401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I 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
0 APPLICANT ❑ 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: branchservice orcu feeder fee,first
56.18 2
City/State/Z1P: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:z:-.....;22„ -,..., Sign or outline lighting 67.84 2
1—� ,� ,. i Signal circuit(s)or limited-energy
Address: ? C�lv panel,alteration,or extension. 0 See Page 2 2
�'P y Each additional inspection over allowable in any of the above
City/State/ZIP:
/44,,i j-"/I e , 57'/ /'e:',/ Additional inspection(1 hr min) 66.25/hr
Phone:(_.. 3) ;•/ -/6,9, Fax:( ) Investigation(1 hr min) 90.00/hr
Email: "7 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 1 �i Electrical Lic.: Suprv.Lic.: specifically listed(V2 hr min)
/c !!vj /�� �d �S 5 ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: f Subtotal: O6. 74'
Print name: -!/."9/,._:7 C ,- Date::jz�j7 0 Plan Review Required(25%of permit fee): ..-------•
State surcharge(12%of permit fee): /A.D g
Authorized signature: TOTAL PERMIT FEE: /j a,,,7�
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,
I:\Building\Permits\ELC_PermitApp_E R ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB