Permit r
" CITY OF TIGARD
ELECTRICAL PERMIT
tipiwg, s v
f o '' COMMUNITY DEVELOPMENT Permit #: ELC2009-00497
T1GARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 09/23/2009
Parcel: 1 S125DA00400
Jurisdiction: Tigard
Site address: 9130 SW 66TH AVE
Subdivision: Lot: 0
Project: Lane
Project Description: (1) branch circuit for furnace conversion.
Owner: FEES
LANE, CHRISTOPHER J Quantity Description Date Amount
P.O. BOX 12092
PORTLAND, OR 97212 1 crt Branch Circuits 09/23/2009 $46.85
wo /Purchase Service or
PHONE: 503 - 706 -8342 Feeder
1 ea 12% State Surcharge - 09/23/2009 $5.62
Electrical
Contractor:
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $52.47
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. ATT ON: Orego law = : ires you to follow the rules adopted by the Oregon Utility Notification Center. T se rules are se forth in OAR
952 -001 010 through OAR 95 0' -0100. Yo. -y obtain a copy of the rules or direct questions to OUNC by calling 503.246.66 1. 0.332.2344.
Iss ed By: A11-41—.L / , A11-4A11-41—.L 1
,� _ Permittee Signature: `r
OWNER NSTALLATION ONLY
The installation is being made on property I own - ich j ' intended for sal ase or rent. 9 �
OWNER'S SIGNATURE / `L I Date: / ��j
/
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.
• Ele'trical Permit Application
,, 'Initt)I I ICI iltil ONI l _t
Received �/ ,,�+(�
III City of Tigard DateB : 4122 % D ' Permit No.: E`^..e,A9
°
AN
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
10 Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit.
I l G
• n It D. Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
. . . _. Internet: www.tigard - or.gov Notified/Method: 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
❑ 1- and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: ...._ Job site address: 97,3 s' l 6". 1 Z, 100 HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: C'y( O 97d ❑ Health -care facilities. ❑ Supply voltage for more than
v/ ❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: 4/v ❑ 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
A/C4' i /'l4 77 ( -Ltf ,' residential (with above sq. ft.)
75.00 2
/ /— Q Services or feeders installation, alteration, and/or relocation
( � 4 S / t I />l 4 (t 200 amps or less 80.30 2
i '0 PROPERTY OWNS I ❑ TENANT 201 amps to 400 amps 106.85 2
Name:
/ 401 amps to 600 amps 160.60 2
�� 5 L� 9h 601 amps to 1,000 amps 240.60 2
Address: 9'/3c7 S /A / 6-eri Over 1,000 amps or volts 454.65 2
City /State /ZIP: / y �d Cie Temporary services or feeders installation, alteration, and /or
/, ��f ( C / relocation
Phone: ( j'(/3 ) 70 6 — Lz'3 4/,,,Z 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 0 CONTACT PERSON' above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, / 46.85 // .k6 branch circuit /
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) 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: Signal circuit(s) or limited -
��A l / /J energy pan, alteration, or
Address: � /`/ extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
. ELECTRICAL PERMIT FEES �
Suprv. Electrician signature, required: Subtotal: 7 a �
Date: 9 23/0i- Plan review (25% of permit fee):
Print name: /�/
fit / State surcharge (12 %ofpermit fee): !1 C '>
Authorized signature: TOTAL PERMIT FEE: 3,"l 7
/ This permit application expires if a permit is not obtained within 180
Print name: �6),/6-,•5- h / fh, Date: 9 j fir- days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 461ST(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 ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: •
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
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