Permit CITY OF TICAR®
D ELECTRICAL PERMIT
I ii,::;1 - :';;P t
e . ^' COMMUNITY DEVELOPMENT Permit #: ELC2010 -00171
T [
Li AR 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/15/2010
Parcel: 1 S 125DD03800
Jurisdiction: Tigard
Site address: 9865 SW VENTURA CT
Subdivision: WASHINGTON SQUARE ESTATES NO. 2 Lot: 46
Project: Kostur
Project Description: Panel & (4) branch circuits for kitchen remodel.
Owner: FEES
KOSTUR, CHARLES J & DIANNE M Quantity Description Date Amount
9865 SW VENTURA CT
TIGARD, OR 97223 1 ea Services or Feeders - 200 04/15/2010 $100.70
amps or less
PHONE: 4 crt Branch Circuits w /Purchase 04/15/2010 $29.68
Service or Feeder
1 ea 12% State Surcharge - 04/15/2010 $15.65
Contractor: Electrical
CHANCO INC
3521 SW CARSON
PORTLAND, OR 97219
PHONE: 503 - 245 -7774
FAX: 503- 244 -4804
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $146.03
Required Items and Reports (Conditions)
This permit is issued sub'ect 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 - ordance with .proved 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. AT NTION: Oregon la r-- 'res you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 1010 through OAR 952 -0h -0100. You • -y obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issu= By: / /:01111Av.,z.....1_ Permittee Signature: w
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. t"
Call 503.638.4175 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 ' � 'i t)10' i I ii 0 N ' '�� hx r + j -i
City of Tigard DateB ,� /0 Permit No.: LC a0 /O oo / 7/
71 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' " Phone: 503.639.4171 Fax: 503.598.1960 DateB : Other Permit:
I I c A It I> In Line: 503.639.4175 Date Ready /By: J�uris: ® See Page 2 for
- Internet: www.tigard- or.gov Notified/Method: / / G Supplemental Information
�� TYPE OF WORK PLAN REVIEW .
❑ New construction E �� iition /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
a1- and 2- family dwelling ❑ Commercial /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.
El A Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Q�n �J , / J 100HP or more. occupancy.
Job no.: Job site address:
7U C.l' � V c' ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 71 I ry —a ❑ Health -care facilities. ❑ Supply voltage for more than
T ❑ 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 1 Qty. I Fee. 1 Total i '
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
DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
t i ,� ` 1 Limited energy, multi- family
I � � - C residential (with above sq. ft.) 67.84 2
C Services or feeders installation, alteration, and/or relocation
812-0-4-k 4'\ 200 amps or less / 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
El APPLICANT above service or feeder fee,
❑ CONTACT PERSON each branch circuit / 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
tY dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2 • CONTRACTOR Signal circuit(s) or limited - energy
Business name: G (- fli- '►A.Ct 1 IA� n r„ e panel, alteration, or extension. Page 2 2
�V ` Each additional inspection over allowable in any of the above
Address: 3 3-2, ( S-c4 ,.\ _ Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: o . „ --� � 2 - `" I G Investigation (1 hr min) 66.25 / hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) 2 al 777 Fax: ( )2 Lad Inspections for which no fee is 90.00/ hr
specifically listed (%z hr min)
CCB Lic.:1 7I '9 . Electrical Lic.<' 0 g Suprv. Lic.: � gg5 ELECTRICAL PERMIT FEES" • •
<< v / Subtotal: /5Q .3
l
Suprv. Electrician signature, required: J
Plan review (25% of permit fee): _-e-
Print name: D a t e : . f / , c s / x i D State surcharge (12% of permit fee): /5 / 5 G 5
!, TOTAL PERMIT FEE: /44 •O 3
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
1:\ Building \ Permits \ELC- PermitApp.doc 10/01/09 440- 4615T(11 /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*
❑ 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:
❑ Audio and Stereo Systems
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n I • nstrumentation
❑ I ntercom 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
1:
\Building\Permits\ELC-PermitApp doc 10/01/09