Permit Electrical Permit Applicatio / �
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City of Tigard ( /`t I °11.E DateB � Permit No.: i ' # wo ,
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; . ° 13125 SW Hall Blvd., Tigard, 722 Pl Review
Phone: 503.639.4171 Fax: 503.598.1 Date/8 : Other Permit:
T A 1:17 Inspection Line: 503.639 n 0 .113 Date Ready/By: 65 See Page 2 for
Internet: www.tigard - or.gov MAY 2 6 Notified/Method: Supplemental Information
TYPE OF WO ' . iv OF TIGAR PLAN REVIEW
® New construction ❑ Addition/alteratio 0 r ' !WOWvls lO1 Please check all that apply (submit 2 sets of plans w /items checked below):
v !WOW ❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition ❑ Other: B where the available fault current
❑ Marinas and boatyards.
CATEGORY OF CONSTRUCT1ON exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- 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 ", "l -3 ",
Job no.: Job site address: 11945 SW 70 Avenue IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, Oregon 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 4 ° 4 (4 \1 144 n die. n ot_e t ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: JC�) ��C Description
Qty. 1 Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I 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 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
67.84 2
Low Voltage Control Wiring 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:
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
relocation
Phone: ( ) I Fa ( ) 200 amps or less 59.36 I
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
m APPLICANT I CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: American Heating, Inc. B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Brian Shea branch circuit
Each add'I branch circuit 7.42 2
Address: 1339 SE Gideon Street Miscellaneous (service or feeder not included)
City/State/ZIP: Portland, OR 97202 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (502) 239 -4600 I Fax: : (503) 239 -7038 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 I
Business name: American Heating, inc. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 1339 SE Gideon Street Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Portland, OR 97202 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 239 -4600 Fax: (503) 239 -7038 Inspections for which no fee is 90 00/
specifically listed ('V: hr min) hr
CCB Lic.: 33135 1 Electrical Lic.: 26993CRE I Suprv. Lic.: 2640LEB ELECTRICAL PERMIT FEES
Subtotal: ?, sg
Suprv. Electrician signature, required: o
tttil Plan review (25% of permit fee): —141==)--, Print name: T Steven Young
Ja ' Date: 4 State surcharge (12% of permit fee): R . ( q
� n /f _ _ TOTAL PERMIT FEE: -7. 9
Authorized signature: A r t t ,� Yx This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete. �� y//)
Print name: Emma J Gordon Date: 5 -24-10 • Number of inspections allowed per permit. (�
I :\ Building \Permits\ELC- PermitApp.doc 10/01/09 4404615T(1 I /05 /COMIWEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: •
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:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -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:
*No licenses are required. Licenses are required
for all other installations
:\ Building \Pamits\ELC- PrnnitApp.doc 10./01/09