Permit �l�,n+ = � o cz cQ c� rti-tv�L -ko r -4- C'tIL S.
II a CI TY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 00593
T i G ;4 R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/03/2009
' Parcel: 2S109AB04600
Jurisdiction: Tigard
Site address: 14268 SW 134TH DR
Subdivision: THREE MOUNTAINS ESTATES Lot: 39
Project: Spezza
Project Description: (1) branch circuit for bar area in game room.ADDED (4) branch circuits to permit.
Owner: FEES
SPEZZA, BUD Quantity Description Date Amount
14268 SW 134TH DR
TIGARD, OR 97224 1 crt Branch Circuits 11/03/2009 $56.18
wo /Purchase Service or
PHONE: 503 - 590 -4778 Feeder
1 ea 12% State Surcharge - 11/03/2009 $6.74
Electrical
Contractor: 4 crt Branch Circuits w /Purchase 11/13/2009 $29.68
OWNER Service or Feeder
0 ea 12% State Surcharge - 11/13/2009 $3.56
Electrical
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $96.16
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. At 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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: �{ Permittee 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:
CONT CTOR STALLATION ONLY
I
SIGNATURE OF SUPR. ELEC' Date: /(// VC) 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.
1
Electrical ECEI V A Jri. ! ° ,„,., '
,,,. `� ry�°'.X 5 1 u.' , .1 r 5! ,„ " I 1 "' « 3 S 3 ..:4M i+ f
ctrical Permit Applicatio b � , FOR OFFICE USE ONLY fi N r '
t
City of Tigard Date/By: Permit No.: fL�70 Qom(. OSg3
13125 SW Hall Blvd., Tigard, OR 972211OV 1 3 2009 Received
g Plan Review
' 10 Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
1 I nspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: luris: ® See Page 2 for
TIG ARf-±
_ Internet: www.tigard - or.gov BUILDING DIVISION NotifiediMethod: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction Addition /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
l- 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.
• ❑ Addition of new motor load of ❑ "A ", "E ", "t -2 ", "1 -3 ", mor
Job no.: Job site address: C/2 S 12 Six or or more re s. occupancy.
/ 7 ( J 7 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: / (��A c q 72- Z� ❑ Health -care facilities. 0 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 1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
/ Limited energy, multi-family
aCka 4/ L . f d erl S � ,�ovt /O� 1 t residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
E GC 2 00 a' - 00 5 200 amps or less 80.30 2
Isi PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: ,C5L c,ez. z_14 401 amps to 600 amps 160.60 2
/ 601 amps to 1,000 amps 240.60 2
Address: / .2 e0 6 (z-2 / 3 L( 64_ Over 1,000 amps or volts 454.65 2
City/State /ZZIP: T n ikel 72_ Z f Temporary services or feeders installation, alteration, and/or
) relocation
Phone: ( ) / Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits – new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
APPLICANT ❑ CONTACT " PERSON - above service or feeder fee, 6.65 2
/^ 7 each branch circuit
Business name:l �� 46 X€ r � (.�- xis B. Fee for branch circuits
; � ` � I '�'' ) without service or feeder fee,
Contact name:
lJa t _ f1 first branch circuit 46.85 2
Address: c s C / //k5 Gp�e_ -1 Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: C G <- h�� 6,...._ q 7 0 2- Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (S — �) 6J "U 0 Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR . Sign or outline lighting 53.40 2
Business name gar ,l/ /–' �1(._ �v Signal circuit(s) or limited -
O "'►'` energyonDescr alteration, or Page 2 2
Address: cc �/l Cis f
City/State /ZIP: l ( ZS 7 1 .0 2 A , � 5 76) 2 7 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.:/6, O 30C Electrical Lic.: 3 -5 ' Suprv. Lic.: yZ 2,9S Industrial plant per hour 73.75
l ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: k Subtotal:
Print name: /e42_,41 /, )_ 1 Date:l� Plan review (25% of permit fee):
(�/�.'L �l" / State sur (8% of permit fee):
Authorized signature: i4_ � TOTAL PERMIT FEE: 3 2
This permit application expires if a permit is not obtained within 18
Print name: /6 <(D Date: R 6 ..3 / G 1 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I: \ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 46I5T(Il /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 ... $75.00
Check Type of Work Involved:
n A udio and Stereo Systems*
n Burglar Alarm
n G • arage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
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
n Landscape Irrigation Control*
❑ Medical
n N urse Calls
❑ Outdoor Landscape Lighting*
n P • rotective Signaling
n O ther
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 03/23/06
;Y , �
o v a CITY OF TIGARD ELECTRICAL PERMIT
� �
' 'Y• COMMUNITY DEVELOPMENT Permit #: ELC2009-00593
T GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/03/2009
s h 4.Nzk:f,t:"
Parcel: 2S109AB04600
Jurisdiction: Tigard
Site address: 14268 SW 134TH DR
Subdivision: THREE MOUNTAINS ESTATES Lot: 39
Project: Spezza
Project Description: (1) branch circuit for bar area in game room.
Owner: FEES
SPEZZA, BUD Quantity Description Date Amount
14268 SW 134TH DR
TIGARD, OR 97224 1 crt Branch Circuits 11/03/2009 $56.18
wo /Purchase Service or
PHONE: 503 - 590 -4778 Feeder
1 ea 12% State Surcharge - 11/03/2009 $6.74
Electrical
Contractor:
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $62.92
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 a in accordanc- with ap• - = plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
d s ATTENTION: Oreg•• -w rer• rc you to follow the rules adopted by the Oregon Utility Notification Center. Those rul-. are set forth in OAR
9 2-001-0010 through OAR • 7-001-0, ou may obtain a copy of the rules or direct questions to OUNC by calling 503.246.••99 or 1.800.33 '4.
// Y
sued By: Permittee Signature: s L
OWNER INSTALLATION ONLY
The installation is being made on property wn which is not tended for sale, lease or rent.
OWNER'S SIGNATURE Date: !f
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
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.
iliMilift Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Received y: 1� $ ¢ /
Date/B O t1 Permit No.: e „...et OTC YdQw
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Reviev
III
0 Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
Date/By:
Inspection Line: 503.639.4175 J uris • I71 See Page 2 for
f I G A IL D Internet: www.tigard - or.gov Date Ready. Notified/Mt / PP a Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Demolition Please check all that apply (submit 2 sets of plans w /items checked below):
(� _. 1 ❑ Service or feeder 400 amps or more ❑ Building over three stories.
1=1 �7 t Addition/alteration/replacement 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 -u agricultural
1- and 2- family dwelling ❑ Commercial/industrial amps for all other installations. buildings.
building ❑ Fire pump. ❑ Installation of 75 KVA or
I=1 Accessory g ❑ Multi - family ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of
El Master builder ❑ Other: ❑ "A ", "E ", "1 -2 ", "I -3 ",
100HP or more. occupancy.
JOB SITE INFORMATION AND LOCATION ❑ Six or more residential units. ❑ Recreational vehicle parks.
❑ Health -care facilities. ❑ Supply voltage for more than
Job site address: Z t0 l am[kJ f � ❑ Hazar locations. 600 volts nominal.
` ❑ Service or feeder 600 amps or more.
City/State /ZIP: ( (Z9 ) � � C FEE SCHEDULE
■ Suite/bldg. /apt. no.: Project name: ., `4Z1j:5 , fr p J Description 1 Qty. 1 Fee. 1 Total 1
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
J Includes attached garage.
( )1--+ — W fr { � , (/- / 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
(with above sq. ft.)
Limited energy, multi - family 67.84 2
Subdivision: Lot no.: residential (with above sq. ft.)
Tax map/parcel no.: Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
DESCRIPTION OF WORK 201 amps to 400 amps 133.56 2
A-9 C7 , 4 �� jc 401 amps to 600 amps 200.34 2
-r � 1 601 amps to 1,000 amps 301.04 2
fi 6---4-41.44 - /1 Over 1,000 amps or volts 552.26 2
, • Temporary services or feeders installation, alteration, and /or
Ltf / PROPERTY OWNER TENANT relocation
200 amps or less 59.36 1
Name: g7U'- P 201 amps to 400 amps 125.08 2
Address: 5Aw '/e 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, er panel
City/State /ZIP: A. Fee for branch circuits with
Phone: ( f 0 * ) q D - I., �-2 Fax: ( ) �j 6h j� above service or feeder fee,
7.42 2
�d' , j T C� each branch circuit
ES /APPLICANT reCONTACT PERSON B. Fee for branch circuits 11 Business name: without service or feeder fee, / 56.18 5 Q • 2
first branch circuit 1
Contact name: G s . �� J� Each add'I branch circuit 7.42 2
Address: ! Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State /ZIP: dwelling, service and/or feeder _
Reconnect only 67.84 2
Phone: ( ) Fax: : ( ') '
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
Signal circuit(s) or limited -
CONT CTOR energy panel, alteration, or
Business name: Q r" j f
(t V 1 ( )11 extension. Describe: Page 2 2
Address: . Each additional inspection over allowable in any of the above
City /State /ZIP: Per inspection 66,25
investigation per hour (1 hr min) 66.25
Phone: ( ) Fax: ( )
Industrial plant per hour 78.18
CCB Lic.: P1, bing Lic. no.: ELECTRICAL PERMIT FEES
Subtotal: 1510 • t g
Authorized signature: Al ' _ _ _ /IL - Plan review (25% of permit fee): 41;
Print name: Date: State surcharge (I2% of permit fee): 6 . ) . .. 7z .,
TOTAL PERMIT FEE: a .
This permit application expires if a permit is not obtained within 180
I:\Building\Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02/COMJWEB) days after it has been accepted as complete.