Permit ELECTRICAL PERMIT
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� , :rfY CITY OF TIGARD COMMUNITY DEVELOPMENT Permit #: ELC2009 -00596
,, , Date Issued: 11/04/2009
cTIGA tly 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S134ACO2652
Jurisdiction: Tigard
Site address: 11150 SW COTTONWOOD LN
Subdivision: Lot: 0
Project: Hunter
Project Description: (3) branch circuits for furnace & a /c.
Owner: FEES
HUNTER, JOHN Quantity Description Date Amount
11150 SW COTTON WOOD LN
TIGARD, OR 97223 3 crt Branch Circuits 11/04/2009 $71.02
wo /Purchase Service or
PHONE: 503 - 590 - 5832 Feeder
1 ea 12% State Surcharge - 11/04/2009 $8.52
Electrical
Contractor:
ERIC OLSEN ELECTRIC COMPANY
11607 NW 33RD AVE
VANCOUVER, WA 98685
PHONE: 360 -609 -4901
FAX: 360 - 693 -2980
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $79 54
Required Items and Reports (Conditions)
Thi •ermit 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
done in accordance with appr. • 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 -w 'requi e .0 to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 thr•ugh OAR 9 -001 110. ay obtain a copy of the rules or direct questions to OUNC by calling 50 6699 or 1.800.332.2344.
1 y
Issued By: - l `, Permittee Signature: //�� YY
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: /(/ 4// r'
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.
< "r � a ,>< i , 'fis � + ,,iTa m t5a , t ,,c-o r r .s ',r • Electrical Permit Application -. , , t .,:;.0 l l S4ff e c 2 �1 4 Y
Received t� D C�aQ�q�vD /
City of Tigard Date/By: // 4 / Permit No.: C-
III
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit.
F i . l G A 1 ,c 1 -3. Inspection Line: 503.639.4175 Date Ready /By: Juns ® See Page 2 tor
. . Internet: www.tigard- or.gov Notified/Method: /`p . Supplemental Information
. , TYPE OF WORK PLAN REVIEW
❑ New construction 0 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.
El 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
- 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 ", "1 -2 ", "I -3 ",
Job no.: Job site address: 1 I r7 p 5 (✓.! C A,d OOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: "r, ��� () uy � C CI Health -care facilities. ❑ Supply voltage for more than
� ( °I 1-7- 3 ❑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 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
.. {� •� Limited energy, multi - family 67.84 2
I) ....J - 1'V tri 6 C l e'�V(l 1 1 "'"C ; 1 C. residential (with above sq. ft.)
J i 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: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that 1 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, per 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
without service or feeder fee, I JJ �� '
Contact name: 56.18 6 b. 2
first branch circuit
Address: Each add'I branch circuit •1/ 7.42 W. 8y 2
Miscellaneous (service or feeder not 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
Signal circuit(s) or limited -
Business name:
ig- (c, 0 (S et +J 4, te- cin— ( `-' energy panel, alteration, or
Address: 0,0 - N 0 3 '3 v d 1477'(- extension. Describe: Page 2 2
City /State /ZIP: 'Val, \ Lea V -C,,/" CU '1 &6 0 5 Each additional inspection over allowable in any of the above
!^ 1 Per inspection 66.25
Phone: ('3.,c ) �J Y� g F ax: (6 ) E 5 3 2, b 0 Investigation per hour (1 hr min) 66.25
CCB Lic.: i 7/ Y 0,y Electrical Lic.: 3 1 -( c53L Suprv. Lic.: lei f Q5 Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: �0 Q Subtotal: 7/ d �+
Print name: ete- ( � ( s c , ; ,J Date: /1/,./ Jp o
Plan review (25% of permit fee): --e---- L State surcharge (12% of permit fee): 8 . 5 2-
Authorized signature: TOTAL PERMIT FEE: 5
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.doc 10/01/09 440- 46t5T(1I /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
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n 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
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n 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