Permit q CITY OF TIGARD ELECTRICAL PERMIT
a i COMMUNITY DEVELOPMENT Permit #: ELC2010 -00437
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TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/24/2010
Parcel: 2S104CA06500
Jurisdiction: Tigard
Site address: 13322 SW HILLSHIRE DR
Subdivision: HILLSHIRE Lot: 65
Project: Davis
Project Description: (1) sub panel and (5) branch circuits.
Owner: FEES
DAVIS, CHESTER R & DEBORAH L Quantity Description Date Amount
13322 SW HILLSHIRE DR
TIGARD, OR 97223 • 1 ea Services or Feeders - 200 08/24/2010 $100.70
amps or less
PHONE: 5 crt Branch Circuits w /Purchase 08/24/2010 $37.10
Service or Feeder
1 ea 12% State Surcharge - 08/24/2010 $16.54
Contractor: Electrical
WEBER ELECTRIC INC
PO BOX 231154
TIGARD, OR 97281
PHONE: 503 - 620 -1906
FAX: 503- 620 -6819
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $154.34
Required Items and Reports (Conditions)
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This permit is ' - - -'- t to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done i• accordance with a•; oved 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. • ENTION: Oregon law - quir= - you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 -0010 thro .h OAR 952 -001 -0 . , '. Y.0 m. • •btain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issu e d By: _ 11 / t Perm ittee Signature: diKliedi� _ .
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: g a
/ (d
LICENSE NO.
CaII 503.839.4175 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 Applicatio n
CE VFD l oa OFFICE: lc l_ X51 c1
City of Tigard nj Re eived AV /) n Permit No.: e /I 3
III ° 1 3125 SW Hall Blvd., Tigard, OR 9722A L., �J u 4 t L'
g Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 DateB : Other Permit.
l t . n It l i; Inspection Line: 503.639.4175 CIT Y OF TIG A ' Date Ready/By: Juris: ® See Page 2 for
- Internet: www.tigard- or.gov ��(R (��� Notified/Method: Supplemental Information
. TYPE OF WORK • PLAN REVIEW
��tt
❑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
r- 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
J013 SITE INFORMATION AND .LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
I00HP or more. occupancy.
Job no.: Job site address: /3 32. 2 r 5Lj N Li S t- rF L r ❑ Six or more residential units.
t � 0 Recreational vehicle parks.
City/State /ZIP: (� ^ c ❑ Health -care facilities. ❑ Supply voltage for more than
L (� ! r;J� �'i Z ? 2 2. 3 ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: J 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
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
[[�� Limited energy, multi - family 75.00 2
?_r ' C- t rct ,_ /� r ("nix te 4t r — Yin Dtt C- residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
5 Cr b p....-.1.1_ 200 amps or less ( 100.70 (oc7 ,Z p 2
PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: AV L 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: lStatelZ[P: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( )
Fax: ( ) 200 amps or Tess 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
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, C 7.42 2
each branch circuit 7
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: r panel, alteration, or extension. Page 2 2
ij
c_.-- F I a ct/`t c ,7 Each additional inspection over allowable in an of the above
Address: Pn iR O X 29 / S Additional inspection (1 hr min) 66.25/ r
City/State/ZIP: _1/5—€1. Investigation (1 hr min) 66.2 h
Ci
ty ( tC r c� DA. 2 2 Industrial plant (1 hr min) 78. 8/ hr
Phone: (S 3) (, a0 9th Fax: (s 3) , 20 - es 7 Inspections for which no fee is 90.00 / hr
specifically listed (%: hr min)
CCB Lic.: Li 1 cD8 7 Electrical Lic.: 3q _4�_ 41 Z t_ Suprv. Lic.: Zi a S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: �i / Subtotal: /3 . gQ
✓` / e Plan review (25% of permit fee):
Print name: ` l� CJcIfr<r— Date: &- _ 1.0 State surcharge (12% of permit fee): /4 • 5e/
TOTAL PERMIT FEE: /5q. 3T
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Num o inspections allowed per permit.
1:\ Building 'Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(11 /05 /CO.WWEB
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*
❑ Burglar Alarm
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❑ Garage Door Opener*
TI Heating, Ventilation and Air Conditioning System*
❑ 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
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n 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: —
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10