Permit CITY OF TIGARD ELECTRICAL PERMIT
a . COMMUNITY DEVELOPMENT Permit #: ELC2010 -00514
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/21/2010
Parcel: 2S110DD08900
Jurisdiction: Tigard
Site address: 15830 SW HIGHLAND CT
Subdivision: Lot: 0
Project: Hodel
Project Description: Panel replacement
Owner: FEES
HODEL REVOCABLE TRUST Quantity Description Date Amount
BY MADELINE M HODEL TR, 15830 SW
HIGHLAND CT 1 ea Services or Feeders - 200 09/21/2010 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 09/21/2010 $12.08
Electrical
Contractor:
ATHENS ELECTRIC INC
15917 NW LOGIE TRL
HILLSBORO, OR 97124 -8152
PHONE: 503 -647 -5823
FAX: 503 -647 -2318
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.78
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 adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through 952 - 001 -0100. You may ob rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued By: Permittee Signature: (W ' £L/ <J 7'7 U
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 503.639.4176 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.
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Electrical Permit Application roll on icl: List: ()NIA
.
City R eceived
of Tigard Permit No.:
a 13125 SW Hall Blvd., Tigard, OR 9 ?% % -<
': C Phone: 503.639.4171 Fax: 503.59.1 t C E E ® P Review
t Other Permi ., _ a S r
T I G n 1 D Inspection Line: 503.639.4175 Date Ready/By: El See Page 2 for
Internet: www.tigard - or.gov SEP 21 2010 Notified/Method: M. Supplemental Information
TYPE OF W LAN REVIEW
1( TIGARD AD
❑ New construction 'Cddition / alte SIDIV Please check all that apply (submit 2 sets of plans w /items checked below):
0 Service or feeder 400 amps or more 0 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.
dwelling less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
and 2-family g ❑ Commercial/industrial ❑ 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 - ", "l -3 ",
Job no.: Job site address: Q k-^-"--
, } { U[n t
100HP or more. occupancy.
D '0 Six or more residential units. 0 Recreational vehicle parks.
City/ State/ZIP: C Z L/. ❑ Health -care facilities. ❑ Supply voltage for more than
`' V 1 1 ❑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 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'l 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
prj1//,e l e residential (with above sq. ft.)
/ Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100.70 100.70 2
, - PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
A „ 1 t tA Q J .1 o f 401 amps to 600 amps 200.34 2
Name: ' V\ G, + 601 amps to 1,000 amps 301.04 2
Address: t S Sj 3 v 5 W � , C ( l G 0 A G is Over 1,000 amps or volts 552.26 2
S e Temporary services or feeders installation, alteration, and/or
City/State/ZIP: `f ,,- j U ci 7 Z Z k f relocation
33Z
Phone: (‘v3) c 1 F ax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is 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
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, 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: / 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
panel, alteration, or extension. Page 2 _ 2
Business name: A 4.■^ -e v-,_ [ t e G A- r i L Each additional inspection over allowable in any of the above
Address: t 5 cl , 7 (l/ h/ L . e `I ,..-- 0, . l Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: \..t ` ( U g Z
S b �� V J 7 Industrial plant (1 hr min) 78.18/ hr
Phone: ( S 0 3) c, t 7 C > s Z F ax ( ) 3 Inspections for which no fee is
90.00/ hr
specifically listed (%r hr min)
CCB Lic.: L(p O Electrical Lic.: 34 t Suprv. Lic.: Z g2ol S ELECTRICAL PERMIT FEES
0 0
'7 t �1 I U�t' 1 Subtotal: 1 . 711
Suprv. Electrician glt e, requiredi : o
Plan review (25% of permit fee):
Print name: 13 1 to ✓� o t e v-42.?, 1-
. Date: c\ Z 0 } t Q State surcharge (12% of permit fee): 1},o:1-
1 TOTAL PERMIT FEE: � i . t X8'
Authorized signature: This permit application expires if a permit is not tained within 180
r days after it has been accepted as co plete.
Print name: 1 Date: