Permit q CITY OF TIGARD ELECTRICAL PERMIT
11 • COMMUNITY DEVELOPMENT Permit #: ELC2010 -00606
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/28/2010
Parcel: 2S111 CCO5300
Jurisdiction: Tigard
Site address: 15910 SW CENTURY OAK CIR
Subdivision: SUMMERFIELD NO. 1 Lot: 76
Project: Eischen
Project Description: (6) branch circuits for interior remodel.
Owner: FEES
EISCHEN, STAN Quantity Description Date Amount
9445 SW BRENTWOOD PLACE
TIGARD, OR 97224 6 crt Branch Circuits 10/28/2010 $93.28
wo /Purchase Service or
PHONE: 503- 440 -2095 Feeder
1 ea 12% State Surcharge - 10/28/2010 $11.19
Electrical
Contractor:
SIBCO ELECTRIC
PO BOX 466
SALEM, OR 97306
PHONE: 503 - 932 -5648
FAX: 503 - 399 -1305
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $104.47
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 OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.804.
IIIIIMINk ..
Issued By: /�— _ / ��� Permittee Signature: y
'ao 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 ��
FOR of l IC USE ONLY City of Tigard ' ' e m 0 �� Permit No.: , iii0J cJ'�o
° 13125 SW Hall Blvd., Tigard, OR 972. 0 , A Plan Review
Phone: 503.639.4171 Fax: 503.5' :1i d Q
Other Permit: , O
�, R�% 1 Date/B : a l U
T I G A x D In spection Line: 503.639.4175 , V r p. to Ready/By: ho S See Page 2 for
Internet: www.tigard- or.gov (�` �v c ,� Notified/Method: Supplemental Information
TYPE OF WORK ����O `
PLAN REVIEW
❑ New construction 18- Addition/alteration/Sp • - t 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.
dwelling less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
JO 1 -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
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "l - ", "I - ",
•
Job no.: Job site address: [ 0 (k 1001 P or more. occupancy.
J V S �.ti 1 — i C r �` ❑Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: i �_ „ f d a�f ��1, 6 ❑ Health-care facilities.
❑ Supply voltage for more than
V � F -r Z F 5 ❑Hazous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: E j SCkQ.h ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Burt tk eription 1 Qtr. I Fee. I 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
l Limited energy, multi - family
° VI S #. Q .mA `A +... 1 . ah residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
A PROPERTY OWNER I ❑ TENANT . 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Sfeah E. 1 5 c.ln 601 amps to 1,000 amps 301.04 2
-1
Address: v `I5 g,,, w o ,d 9\ 12. Over 1,000 amps or volts 552.26 2
e'� n Temporary services or feeders installation, alteration, and/or
City/State /ZIP: 1 1 , A1r 9 0 , CI 7 27 U relocation
Phone: (S03.) 1 0 , ...2Qo15 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 -
401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
0 APPLICANT CONTACT PERSON above service or feeder fee 7A2 2
each branch circuit
Business name: 11 ,,a
�L 1Mt w�@' Co►SL ^( t U Lt 1 L B. Fee for branch circuits without service or feeder fee, first
1 56 tj� 2
Contact name: branch circuit ✓
1 LC 1r�S �� Each add'I branch circuit 5 7.42 ,37/0 2
Address: p o, VO 151 Miscellaneous (service or feeder not included)
�00d U � , O 'e CV 01 t Each manufactured service or modular
City /State /ZIP: D dwelling, service and/or feeder 67.84 2
Phone: (S� ) 1SLI _21 Q 3 Fax: : ( ) Reconnect only 67.84 2
v - Pump or irrigation circle 67.84 2
E - mail: 11 QpivOdei 0 -tgv, 00 cow\ Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
•
Business name: C / /3 e / /x_ panel, alteration, or extension. _ Page 2 2
Each additional inspection over allowable in any of the above
Address: AO , ( i,r ( Additional inspection (1 hr min) 66.25/ hr
CCC Investigation (1 hr min) 66.25/ hr
City/State /ZIP: c_ /ems D .97,g5le Industrial plant (1 hr min) 78.18/ hr
Phone: ) 9 3 2 5 6 4 8 Fax: ( ) c9ctc4 t2 . T ' Inspections for which no fee is
specifically list (%2 hr min) 90.00 / hr
fica
CCB Lic.: /59525- Electrical Lic.• V-5741 Suprv. Lic.: gS? ELECTRICAL PERMIT FEES
Ii / Omiii:2_43 9 3 Za
Suprv. Electrician signature, required � .k., Plan review (25% of perm
Print name: 30110 6 /+ i ir l S t ^ Date: /D _ 2 / o State surcharge (12% of permit fee):
Authorized signature: CJ TOTAL PERMIT FEE: /0 . S
This permit application expires if a permit is not ob ' ed within 180
Print name: Date: • days after it has been accepted as com te.
Number of inspections allowed per permit. , 1.17
1:\ Building Temits\ELC- PermitApp.doe 07/01 /10 440- 46I5T(11/05 /COM/WEB