Permit CITY OF TIGARD ELECTRICAL PERMIT
l3 COMMUNITY DEVELOPMENT Permit#: ELC2010 -00608
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/29/2010
Parcel: 2S112BC10600
Jurisdiction: Tigard
Site address: 8256 SW MATTHEW PARK ST
Subdivision: MATTHEW PARK Lot: 5
Project: Benson
Project Description: 1 hour of inspection time to inspect work done for bathroom remodel.
Owner: FEES
BENSON, BARBARA J Quantity Description Date Amount
8256 SW MATTHEW PARK ST
TIGARD, OR 97224 1 hr Hourly Electrical Rate 10/29/2010 $90.00
PHONE: 503-670-9794 1 ea Hourly Electrical 12% 10/29/2010 $10.80
Surcharge
Contractor:
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $100.80
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 accor 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. ATTE ON: Orego law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -00 through OAR 952 -001- ///►►► u may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B :
` /p/� Permi ttee Signature: t:(A% c�
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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 ()F1 1Ci; USE; ONLY
City of Tigard /p A " Permit No.: .. L C, o /o— '
° 13125 SW Hall Blvd., Tigard, OR 97223 Received Plan Review
DateB : I •
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
r i t; n It i > Inspection Line: 503.639.4175 Date Ready/By: kids: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement 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.
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 ", "1 -2 ", "1 -3 ",
lob no.: Job site address: �j C / ) ��� J Q` 100 or more occupancy.
S ) v, tTf/ /Q�il / L / ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: t -b' ( ��^� C 7Z7/1 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.. Project name: /2509V ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 0 i /s/4 Desciption 1 Qty. 1 Fee. 1 Total 1 •
l� Q � �o� � �C �. � garage.
New residential single-multi- fam dwelling unit.
Includes attached
Subdivision: Lot no.: 1,000 sq. ft. or Tess 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
00 /L �� � A /
Limited energy, multi-famil 75.00 2
residential above (with above e sq. q. ft.)
S ervices or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 4',6, dY\ 601 amps to 1,000 amps 301.04 2
Address: gZ 50 5- / rK a S/ Over 1,000 amps or volts 552.26 2
(�`� J r / / l Temporary services or feeders installation, alteration, and/o
City/State /ZIP: �'�°'YO'/ (2/€ relocation
Phone: (,3) 70 - 9'i9 5 1 Fax: ( ) 200 amps or less 59.36
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 z
intended for sale, le rent, or exchan according to 0 RS 447, 449, 670, and 701. 401 amps to 599 amps 168.54
1 1-1
Branch circuits — new, alteration, or extension, per panel
Owner si gn ature L / d� Date: i ° 745//0 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 � ,J,
Each add'I branch circuit ' WCi 7.42 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: 040/L) f panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (I hr min) 66.25/ hr
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 (% hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: q(J ad
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): /Q • O b
TOTAL PERMIT FEE: le/ .4'o
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.
N um be r of inspections allowed per permit.
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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
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