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Permit
_ �' CITY OF TIGARD ELECTRICAL PERMIT li COMMUNITY DEVELOPMENT Permit #: ELC2010 -00441 TI G A R L) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/25/2010 Parcel: 2S103DA06300 Jurisdiction: Tigard Site address: 10920 SW PARK ST Subdivision: MIRA PARK Lot: 1 Project: Wolfrum Project Description: (3) branch circuits for bathroom remodel. Owner: FEES WOLFRUM, J T DELANE AND ALICIA Quantity Description Date Amount 10920 SW PARK ST TIGARD, OR 97223 3 crt Branch Circuits 08/25/2010 $71.02 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 08/25/2010 $8.52 Electrical Contractor: 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 $79.54 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: Oregon law requires you to follow the rules ado. -d by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR • _ :.1 -0100. You -y o. -' a copy of - ±rrA! ... -s ions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: c...-.." / ...::••"" - —� � �% Permittee Signature: �i�r, t .• ' 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. CaII 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. Electrical Permit Application l f)lr( rlC l::util: O I. City li` 1114 aA Q , Za a - Received ? P No.: t 1 131 of Tigard SW H al Blvd., Tigard, OR 97223\' � � � `�' �'� DateB • © ,�) ( __.03 J g 1. - i Plan Review 0 ' � � Other Permit: (/ I . Phone: 503.639.4171 Fax: 503.598119�� _ ,;~ ` w DateB L) r I c . n l;1) Inspection Line: 503.639.4175 � Gj �- Date Ready/By: ® See Page 2 for Internet: www.tigard - or.gov AEG t .-,Q Notified/Method: 7 Supplemental Information r � \t ,, TYPE OF WORK "` \ A\P !v - PLAN REVIEW • ❑ New construction ,g Addition /alteration/replacertie4 \'''' - Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Demolition ❑ Other: l) .\, `\ ' . ❑ Service or feeder 400 amps or more ❑ Building over three stories. 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 tom- 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 ", "I -2 ", "1 -3 ", Job no.: Job site address: O cl C& 5( (.)r k sr Six or or more residential R occupancy. / ❑ Six or more residential units. ❑Recreational vehicle parks. City/State /Z[P: p Q 2 Z ? ❑ Health -care facilities. ❑ Supply voltage for more than l� l J ❑Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: /Tr.-v.( roject name: WO l Yr/tr'\ ❑ 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 ne°e.%)/ mil 3 ck $ `Devi h re re-t oeXeX residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: �/ 1,001 V w-, 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 n relocation Phone: ( ) Fax: ( ) 200 amps or less 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 ❑ 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, first Contact name: branch circuit 1 56.18 - j , i b 2 Each add'I branch circuit 2 7.42 ( 44 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 �� x �^ panel, alteration, or extension. Page 2 2 !�. a 7e r rte ..Lrt t - Each additional inspection over allowable in any of the above Address: pt7 I`� n 2.. 3(i Sq Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: �' .../ n Investigation (1 hr min) 66.25/ hr 15 41cn -7 � , �t2 Q � i . � Industrial plant (1 hr min) 78.18/ hr Phone: ( ) 22o _ (, 06, Fax: (C, 3) 20 _ 17 Inspections for which no fee is 90.00/ hr c specifically listed (V2 hr min) CCB Lic 1 7 Electrical Lic.:34 _ 9 4 z el Suprv. Lic.: 4 0 Zk S ELECTRICAL .PERMIT ;FEES Suprv. Electrician signature, required: .?1i� / j ems', Subtotal: 7 /, p Z '' // K Plan review (25% of permit fee): Print name: in t Ga7 L- Jeb-cr- Date: 8,..2 State surcharge (12% of permit fee): 8 5 2 TOTAL PERMIT FEE: 7 9. 5ZI 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. Number of inspections allowed per permit. I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(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* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: n Audio and Stereo Systems ❑ B oiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation n F • ire Alarm Installation n H VAC n Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls n 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 07/01/10