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Permit I 1I key i - W fexM'i - t - fie) kc + a CITY OF TIGARD ELECTRICAL PERMIT '-1 COMMUNITY DEVELOPMENT Permit #: ELC2010 -00695 T I G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/16/2010 Parcel: 2S103ACO2900 Jurisdiction: Tigard Site address: 12465 SW 112TH AVE Project: SALING Subdivision: MCMICHAEL HEIGHTS Lot: 7 Project Description: Upgrading service panel to 200 amps. 1/04/11, reprinted permit to include (1) feeder and (11) branch circuits. BT. Contractor: OWNER Owner: SALING, WALTER ALLEN 12465 SW 112TH AVE TIGARD, OR 97224 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 12/16/2010 $100.70 Specifics: amps or less 1 ea 12% State Surcharge - 12/16/2010 $12.08 Type of Use: SF Electrical Class of Work: ALT 11 crt Branch Circuits w /Purchase 01/04/2011 $81.62 Service or Feeder Type of Const: 22 12% State Surcharge - 01/04/2011 $21.88 Occupancy Grp: Electrical 1 ea Services or Feeders - 200 01/04/2011 $100.70 amps or less Total $316.98 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 issuer' .7 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 Ce er. hose -s are set forth in OAR 952 - 001 -0010 through 0A • . ;01-0090. You may obtain • • • • .. • les or direct questions to OUNC by calling 503.23 . 98' r / 110.332 -4. Issued By: ''' a .L. = ` ermittee Signature: / I /. 4 t_411 NER 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 the next available inspection date. 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. CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2010 -00695 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/16/2010 Parcel: 2S 103ACO2900 Jurisdiction: Tigard Site address: 12465 SW 112TH AVE Project: SALING Subdivision: MCMICHAEL HEIGHTS Lot: 7 Project Description: Upgrading service panel to 200 amps. Contractor: OWNER Owner: SALING, WALTER ALLEN 12465 SW 112TH AVE TIGARD, OR 97224 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 12/16/2010 $100.70 Specifics: amps or less 1 ea 12% State Surcharge - 12/16/2010 $12.08 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 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 is • ance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rule . .. • • • - • by the Oregon Utility Notification Cent: r. T e rules are set forth in OAR 952 - 001 -0010 through OA�.,— • -0090. You may ...:' a copy o 'Y r - s.or direct •uestions to OUNC by calling 50 . 3.. or 1.8 0.332.2 [4. Issued By -- /_s. ' / =��� Permittee Signature: r _ 1_ l ' 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. CaII 503.639.4175 by 7:00 a.m. for the next available inspection date. 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 (v . n, p 7 FOR OFFICE tISF ONLY ' � s i s 1 '' i • � City of Of Tigard Received ©���� Permit No.: L _Cw . 13125 SW Hall Blvd., Tigard, OR 97223 P lan Review lIl Phone: 503.718.2439 Fax: 503.598.1960 SEC 3 0 20 Dateiv 10 Date/ Other Permit: I I c. A RD D Inspection Line: 503.639 Date ReadyB ® See Page 2 for Internet: www.tigard A r - ' . 'J 1 Notified/Method: Supplemental Information TYPE OF WORN IILDING OIVbI`J ° 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 ", Job no.: Job site address: I OOHP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total I • 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 Limited energy, multi - family 75.00 2 a / y ((I) b,N «' r CA cr r c-4 Gyve" residential (with above sq. ft.) \ J Services or feeders installation, alteration, and/or relocation C ( - Pe.P---e4Ar y I D rvTV_- 200 amps or less 1 100.70 /it 70 2 ❑ P OPERTY OWNER ❑ 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 h relocation _ Phone: ( ) 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 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 / ❑ APPLICANT CONTACT PERSON above service or feeder fee El 7 42 1,w- 2 each branch circuit 4 D' Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit . Each add'l branch circuit 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: panel, alteration, or extension. Page 2 _ 2 Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (I 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: �,Z,'3 Plan review (25% of permit fee): Print name: ` A e Date: State surcharge (12% of permit fee): ??r C TOTAL PERMIT FEE: 9 LI, Authorized signature: I ` k C\ This permit application expires if a permit is not obtained within 180 J days after it has been accepted as complete. Print name: ) LT _ ,6131 L / Date: / — 9 - / 1 + Number of inspections allowed per permit. ', 1:Building\Pennits \ELC- P 07/01/10 440-4615T(1I /05 /COM/WEB Electrical Permit Application �NIa � FOR O I Q FFICE USE ONLY City of Tigard �o DIV °11 o C 1� Received Date/B : m / Permit No.: 7.-,- � - sL a '. 5- Ill 13125 SW Hall Blvd., Tigard, OR 97223 -t Date/B Plan Review Phone: 503.718.2439 Fax: 503.598.1960 W`o�, 9 M. - Other Permit: TiGARD Inspection Line: 503.639.4175 Date Ready/By: p,ri ' ® See Page 2 for Internet: www.tigard- or.gov aD ,i otified/Method: ( Supplemental Information TYPE OF WORK l iCiW U PLAN REVIEW ❑ Addition/alteration/replacement ❑ N ew construction 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 El 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 ", Job no.: Job site address: ! l,,, 5 SG(/ ( l or more. occupancy. / �� f ❑ Six x o or r more residential units. ❑ Recreational vehicle parks. City /State /ZIP: )� ve ) J OR � 7 ❑ Health -care facilities. ❑ Supply voltage for more than • / L ` }/ / /�/ ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: �y /,� • // J ``L. ❑ Service or feeder 600 amps or more. C / ((//►► FEE SCHEDULE Cross street/directions to job site: Description I Qty. � 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 Ea. add'l 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 Limited energy, multi - family Up ii e e 1 Pcio t 64.1 S ervlc- plaite residential (with above sq. ft.) 75.00 2 Services or feeders installation, alteration, and/or relocation A 0 0 e( � 200 amps or less i 100.70 1(. , 71 2 PROPERTY OWNE ❑ TENANT 201 amps to 400 amps 133.56 2 / � 1 401 amps to 600 amps 200.34 2 Name: I f t �� c 601 amps to 1,000 amps 301.04 2 Address: l Alt & 5 sit, 9 - l /A f A. v ,, l , C Over 1,000 amps or volts 552.26 2 , !N L Temporary services or feeders installation, alteration, and /or City/State/ZIP: Y j j 4 Ud l p f (1 relocation Phone: 5-D3 - c / Fax: ( ) 200 amps or less 59.36 .1 < j is 201 amps to 400 amps 125.08 2 • Owner installation: Th• installll s bein! ade on property that I own which is not intended for sale, lease, re t • • Ilion • c ge, a• ordin to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 `I ' _ r 9,-ile--7() Branch circuits - new, alteration, o extension, per panel Owner si g nature: , 4 _ + i �' Date: A. Fee for branch circuits with W above service or feeder fee, ❑ APPLICANT C CONTACT PERSON 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 • Each add'I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 2 Y 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. Pa 2 2 Each additional inspection over allowable in any of the above Address: Additional inspection (1 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 (%z hr min) CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: U(� 0 Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): 1a-• 0 y 0.. `� TOTAL PERMIT FEE: , 0 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(I 1/05 /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- PertnitApp.doc 07/01/10 IF 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. or _X 1 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. D c f1ev, - 54 Pri t N R ) d rmit Applicant l ll 1 6 Signature of Permit licant Date 9 PP Permit #: � �/9 - 0 id-006 r S Address: 1 Y16'ci Stil `!f) - -,!'e . ` /r;4 Issued by: Date: 0/42/d This Copy for Permit Offices