Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00663
T I G AR h; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 12/16/2009
Parcel: 2S 102 BD03200
Jurisdiction: Tigard
Site address: 13075 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Denture Design
Project Description: (2) branch circuits.
Owner: FEES
SANCHEZ, J GUADALUPE & Quantity Description Date Amount
ZAVALA, BLANCA E, 13075 SW PACIFIC HWY
TIGARD, OR 97223 2 crt Branch Circuits 12/16/2009 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 12/16/2009 $7.63
Electrical
Contractor:
DICKINSONS ELECTRIC
8449 SW BARBUR BLVD
PORTLAND, OR 97217
PHONE: 503 - 246 -3550
FAX: 503 - 213 -6049
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This p it 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 d e in accordance with a roved pl This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days ATTENTI9N: Oregon lain re tAfes Vo follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 01 -0010 thrbugh OAR 952 -001;0 0. u ay' btain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.80. - 44.
Iss d B� Permittee Signature: y. /
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 INSTAL TION ONLY
SIGNATURE OF SUPR. ELEC' r Date: /,---/X
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 t E ° .• r , i (,I R.0I i IG I; US () N, ,, " .,' # ' >. . .p
City of Tigard Date/By: ( � � 7 Permit No.: � l�a�� �.
1 1111
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
'•' Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit:
FIG t A R I ': Inspection Line: 503.639 Date Ready/By: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: � Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ddition/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 stones.
❑ 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
❑ 1- and 2- family dwelling ommercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
12 A Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: /362
IOOHP or more. occupancy.
/. �, ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: { ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous 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. 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
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
/ , Limited energy, multi - family 67.84 2
l /fi /..:4 il ,« .- - ' residential (with above sq. ft.)
II al, - Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER • ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 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
Branch circuits - new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT. PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, / 56.18 2
first branch circuit
Address: Each add'l branch circuit 7.42 2
Miscellaneous (service or feeder of included)
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR • ' • Sign or outline lighting 67.84 2
y �
� �! -- Signal circuit(s) or limited -
Business name: ���i7�, i �J
C� l7 � energy panel, alteration, or
�� j �j c `d k extension. Describe: Page 2 2
City /State /ZIP: �4�� p �° >/, Each additional inspection over allowable in any of the above
�+ ) `� Per inspection 66.25
Phone: ( 15/ 3 ZeI 2_, I Fax: ( rj'e 73460 9 Investigation per hour (I hr min) 66.25
CCB Lic.: 6^ ` I Electrical Lic.a ,�, _ _ ' prv. Lic.:3 /2s Industrial plant per hour 78.18
�P i ELECTRICAL PERMIT FEES
Suprv. Electrician signature, req • ' e • ��j -� -- - — Subtotal: 63, ( 0
Print name: Date: Plan review (25% of permit fee): ---C -
State surcharge (12% of permit fee): 7. 4'3
Authorized signature: TOTAL PERMIT FEE: 7/. 02 3
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.
1:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(1 t /05 /COM/WEB
Electrical Permit Application - City of Tigard .>
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
•
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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