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Permit
CITY OF TIGARD ELECTRICAL PERMIT 0 COMMUNITY DEVELOPMENT Permit #: ELC2010 00577 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/19/2010 Parcel: 2S102DC00510 Jurisdiction: Tigard Site address: 9115 SW EDGEWOOD ST Subdivision: Lot: 0 Project: Larsen Project Description: Owner: FEES LARSEN, PAUL Quantity Description Date Amount 9115 SW EDGEWOOD TIGARD, OR 97224 13 crt Branch Circuits 10/19/2010 $145.22 wo /Purchase Service or PHONE: 503 -639 -6325 Feeder 1 ea 12% State Surcharge - 10/19/2010 $17.43 Electrical Contractor: OWNER • PHONE: FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $162.65 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 • suance, or if wo . 's suspen• • for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifi on Ce - . hose' rules are set forth in OAR 952- 001 -0010 through 0 R 952- 001 -0100. You may obt ' f the rate direct questions to OUNC by callin 5 .246: •9• • 1.800.332. • • 4. Issued B Permittee Signature: 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. 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. Electrical Permit Application rclli ()rrici: usl: ONix j 1 City of Tigard CS ` - DateBy: Received In 1 / 0 7 Permit No.: 1 L C 1 LQ ,� c d S-r 7 ° 13125 SW Hall Blvd., Tigard, OR 97223 �•/ Plan Review � • '� Phone: 503.639.4171 Fax: 503.598.1960 2c`Q Date/By: Other Permit: / ' 'V 3 - j X _ 00 i t q rJ 1.1 i . i Inspection Line: 503.639.4175 ) CV . 1 u Date Ready/By: Juris: ® " ' See Page 2 for �— Internet: www.tigard- or.gov � . Date 'r T' Supplemental Information TYPE OF WORK Cl'1� °FG1)1 %0014 1 PLAN REVIEW ❑ New construction ❑ Addition/alteration/re Please check all that apply (submit 3 sets of plans w /items checked below): D" - �� ❑ 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 ❑ 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.: I Job site address: Wi'" 5 4 7 1� 5/ Six or or more. occupancy. 7 ! ` J i i ❑ Six or more residential units. ❑ Recreational vehicle parks. Cit /State /ZIP: �n !� '�` ❑ Health -care facilities. ❑ Supply voltage for more than y 7 �41 d1� �` �i.� ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: , (f v?at ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: //ALL ex © A pl_ 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 Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1 Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) ` Limited energy, multi - family 75.00 2 6 2 J 1 tt / residential (with above sq. ft.) J �i 1'Ct� r c � M�+c " . ✓ S Services or feeders installation, lilt : i/ , n . or relocation 200 amps or less [I 40T-7A, 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: A to L ft, /4 S? Z 601 amps to 1,000 amps 301.04 2 Address: t ? //'5 J r, 4 ) E o aj ,g.-7- Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City/State /ZIP: 77 ( 4 r (--_.) ( -?7 Vg-5 relocation Phone: 0"3) T9 b 3 Fax: ( ) / 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: T . install . lion iabein l made on property that I own which is not — intended f o r sale, l e . ' - , ent, t r - an, : ccordin: t ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits — new alteration or extension . er . anel _ Owner signature: % ■,,„z. _ Date: 0^7?- 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 / 56.18 (�' 2 Contact name: branch circuit r Each add'I branch circuit 1,1- 7.42 F, oil 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: panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: l A/E.,(2.___ Additional inspection (1 hr min) I I 66.25/ hr 1 City/State /ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00/ hr specifically listed (%z hr min) CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: / 1- (S - 2 N., Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): i 7. t43 TOTAL PERMIT FEE: ( (Q a,• Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: • 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 ONLY: Fee for each commercial $75.00 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 I:\Building\Permits\ELC- PermitApp.doc 07/01/10 f Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. ►i I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. A vg I leiR 5:1C Prin me of - - rmi ' • Iicant i_ 01 -=- ■ /'– /2 Signature of Permit Applicant Date Permit #: 'L C av 'o —UU S 7 Address: c T / ( 5 i civ x = C 7, 04 , de q7a -a-3 . Issued by: 6. i • Date: i0 lq /lU t-ia This Copy for Permit Offices