Permit " CITY OF TIGARD EL PERMIT
. COMMUNITY DEVELOPMENT Permit*: ELC2010 00040
TIGAcRD; 13125 SW Hall Blvd., Tigard OR 97223 503.639:4171
Date Issued:, 01/22/2010
. Parcel: 2S 111 CA02700
Jurisdiction: Tigard
Site address: 15466 SW SUMMERFIELD LN
Subdivision: Lot: 0
Project: Trachsel
Project Description: Alter (1) 200 amp feeder„ add /alter (3) branch circuits. ,
Owner: FEES
TRACHSEL, MERNA I Quantity Description Date Amount
15466 SW SUMMERFIELD LN
TIGARD, OR 97223 1 ea Services or Feeders - 200 01/22/2010 $100:70
amps or less •
PHONE: 3 crt Branch Circuits w /Purchase 01/22/2010 $22.26
Service or Feeder
1 ea 12% State Surcharge - 01/22/2010 $14.76
Contractor: Electrical
ERIC OLSEN ELECTRIC COMPANY
11607 NW 33RD AVE
VANCOUVER, WA 98685
PHONE: 360- 609 -4901
FAX: 360- 693 -2980
•
Type of Use: . 3F
Class of Work: Al Type of Const:
Occupancy Grp:
Total $137.72
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 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: Ore. .n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 though OA • .952-001-0,100. You may obtai a copy of the rules or direct questions to OUNC by calling '503. 246.6699 or 1.800.332.2344.
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Issued By: `- •k1! . 1. _ 1 .. I _. A 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:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' ... -- Date:
LICENSE NO. Z i (Of
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
.
This permit card shaft 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.
E lectrical Permit Application " '' ° ' ' " i ° Ylj i ' ` o' r tFic E "`;usi q "ti L ti "^ ,'f a f , ,� k ^ u t 1 ty` w �,, °; i
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City- of Ti JAN 2' 2010 Deceived _.,
° 13125 SW Hall BIvd., Tigard, OR 97223 T Other Permit: -
Pl an Review
Phone: ,503.639.4171 Fax: 503:598.1.9 OFTIGARD Date /By: O
Inspection Line: 503.639.4175 i D ate; Read /B Juris: ; ® See P a e 2 for
rlc Ali D p BUILDING 'DIVISION y o: g
intemet www tigazd -or gov nfied/Meth d. i � C Supplemental l
No ' o uformafion
TYPE; OF WORK', = u_ �• 'PLA ,. J
❑ . New construction ,ddition/alteration / rephCement Please check all `that ' apply (submit :2 sets of plans w /items checked below)a
's
❑ Service or feeder, 400 am p or more ❑ Building over three stories. •,
El , Dem011tlOn ❑ Other: wh ere 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
X 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for•all other installations. buildings.
❑ Multi - family ❑ Master builder; ❑ Other: ❑ Fire pump. ❑ Installation of 75 ICVA or
Emergency system. arger:separately derived y
• ; JOB SITE - INFORMATION , AND LOCATION
I ds system.
_, ,, ..,.,,. .. . . 74 ❑ Additron of'new motor load of ❑ `A” " `E "1 -2" "1 -3"
i L i { e ,/ l00HP or more occupancy,
Job no.: Job site address: 1 (� to J (� S UWlme/�je 1 W ❑ Six or more residential units. O' Recreational vehicle parks.
City/ 1 ❑ Health -care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: 1 22- '� IN-R.--- 0 Service or feeder 600:amps or,more.
r. ° .FEE SCHEDULE _ _ -
CrOss street/directions to Job site: Description 1 Qty. 1 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 I
Tax ma / arcel no • I DESCRIPTION" OE WORK
,t (with energy, residential 67:84 2
p Lim
with above'sq. ft.)
Limited. energy, multi- family 67.84 2
'/',� o k -C � o l et yX d residential (with above sq. ft.)
C i t 200 V amps or less / alteration, 2
and/or relocation
installation, at relocatio
�••� on, alter
❑..PROPERTY OW ERI • ` ®;`TENANT, , . '' 201 amps to 400 amps 133.56 2
• Name: ('-'- tc. T ( ,.s..Q� 601 am to 6 boo am 200.34 2
p amps 301.04 2
Address: l'cirk ,e cl 5 CI ..W-e___ Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services'or feeders installation, alteration, and /or
relocation
Phone: (5 ) C Zo 6,63 ( Fax: ( ) 200 amps or less 59.36 1
Owner instillation: This installationis'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
Owner signature: Date: A. Fee for branch ,new, alteration, or-extension; t er panel
Branch circuits -
circuits with
❑` APPLICANT • 4 ❑ ° CONTACT, PERSON " ` above;service or feeder fee,
2 7.42 2
each branch circuit
Business name: B: . Fee , for branch circuits
Contact name: without.service'or feeder fee, 56.18 2
frst> branch circuit
Address: Each add''I branch'circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or-modular 67.84 2
dwelling, service and/orfeeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
.,',- ' '. :.' " - .l- CONTRACTOR °' .• ," _, , • Sign or outline lighting 67.84 2
/ Signal circuit(s) or limited-
Business name:
OYL (C- 0 (S I U-e c4 i t C) energy panel, alteration, or
Address: 100 1 7) 0 Z 5
/
e- el / tame 32- extension. Describe: Page 2 2
City /State /ZIP: j L b•u - I Li k 0.181465 Each additional inspection over allowable in any of the above
v Per inspection 66.25
Phone: ( 34o ) 6o y Y90( Fax: (3 GO) to '3 3 2-`i 80 Investigation per hour (1 hr. min) 66.25
CCB Lic.: ("7 ci i, f Q > Electrical Lic.: S3G Suprv. Lic.: L e : 9 ( 0 5 Industrial plant per hour 78 18
o , _ _, " . FEES, S- 'i' !
Suprv. Electtician signature, required: ��," Subtotal:
c
Print name: t (J ,So -1 Date: i/2�I iV Plarrreview(25 %of permit fee):
( 11 ( State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: `� �. 1
This permit application expires if a permit is not obtained fan.
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- 4615T(11/05/COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
•
LIMITED ENERGY PERMIT FEES:
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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*
❑ Other:
p° COMMERCIAL`WORK°ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918 - -0000)
Check Type of Work;Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑
Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*■o licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 10/01/09