Permit f�a �
- CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00373
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/24/2009
TIGARD Parcel: 1S136AC04700
Jurisdiction: Tigard
Site address: 10670 SW 75TH AVE
Subdivision: PP1998 -145 Lot: 3
Project: Hanson
Project Description: Adding 200 amp or less panel, add /alter (3) branch circuits.
Owner: FEES
HANSON, CHARLES D & CHRISTINA D Quantity Description Date Amount
10670 SW 75TH AVE
PORTLAND, OR 97223 1 ea Services or Feeders - 200 07/24/2009 $80.30
amps or less
PHONE: 3 crt Branch Circuits w /Purchase 07/24/2009 $19.95
Service or Feeder
1 ea 12% State Surcharge - 07/24/2009 $12.03
Contractor: Electrical
•
PHONE:
FAX:
•
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.28
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 applic -.le 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 w•rk is .us, nded for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification C� . ' ose ru - 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 4%6766 or .:00. :2. 4.
Issued By: X11 / ' 1 1 Permittee Signature: ^ i = ∎ ■-
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
KtUtiVti) L . . . . FOR.O U ONLY
JUL 2 4 2009
City of and
Ti Received Permit No.: /� �y/q �7
El
Tigard
Date/By:
E C, _,Cy, c q •�Jll� J
13125 SW Hall Blvd., Tigard, OR 97223 �+I-�Y OF �IGARD Plan Review
Phone: 503.639.4171 Fax: 503.598.1960/ r Date/By: Other Permit:
lial Inspection Line: 503.639.4175 DIVISION Date Ready/By: • Jur is: ` : ® See Page 2 for
Internet: vvww.tigatd or.gov gUILDiN`.71 Notified/Method: 1 t; Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ja 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ",
Job no.: Job site address: f /� (� C' / 1� �� IOOHPormore. occupancy.
I I J V J W J vL ❑Six or more residential units. ❑ Recreational vehicle parks.
Cl /S/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
• City/State/ZIP: A ✓0 O 2_1 ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: l� I` ❑ Service or feeder 600 amps or more.
( (/ FEE SCHEDULE
Cross street/directions to job site )) `�� \-1 t1 - Description 1 Qty. 1 Fee. 1 Total
i JJJ I New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
2 1 4 j Limited energy, multi-family 75.00 2
K \Jo � J � ty,., ti �x t V ti e, v, (7 T 0 Ac IL <pc! re (with above sq. ft.)
(� , Services or feeders installation, alteration, and /or relocation
� �1 t.-, �CD lk rc ` g G✓ 4 Z" 1S ls,r,� a�L�, :��1�-- 200 amps or less 1 80.30 2
PROPERTY OWNS ❑ TENANT -) 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
t� I °�11S6h 601 amps to 1,000 amps 240.60 2
Address: I Q l 0 \, v „ 4 1 I AV r Over 1,000 amps or volts 454.65 2
1 Zz Temporary services or feeders installation, alteration, and /or
City /State /ZIP:
,A O relocation
Phone: (S.C.) 7o ` 1 1 S 0 Fax. . +v ''F.,Zzl 200 amps or less 66.85 1
Owner installation: This 'I itall. ion is I ; ing made on property that I own which is not _ 201 amps to 400 amps 100.30 2
intended for sale, I•: e, r ,', or -xcha 7 according to ORS 447, 449, 670, and 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: �,, :S Date: 1 12� �� A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSO above service or feeder fee, 6.65 2
each branch circuit
Business name: 13. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( )
Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: 1 t 1• p8
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\ BuildingWermits \ELC- PermitApp.doc 05/23/06 440- 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:
n 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:
n Audio and Stereo Systems
❑ Boiler Controls •
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I. \ Building \Permits\ELC- PermitApp.doc 03/23/06