Permit CITY OF TIGARD ELECTRICAL PERMIT
.art Permit #: ELC2011 -00004
COMMUNITY DEVELOPMENT Date Issued: 01/05/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
4
Parcel: 25111 CB05500
Jurisdiction: Tigard
Site address: 15215 SW 100TH AVE
Project: Aho Subdivision: LONDBERG MLP2000 -00008 Lot: 2
Project Description: Upgrade existing 100 amp panel to 200 amp panel with meter replacement. 6/23/11, reprinted to add (10) branch
circuits to scope of work.
Contractor: OWNER Owner: AHO, JONATHAN E
15215 SW 100TH AVE
TIGARD, OR 97224
PHONE
PHONE: 503 - 407 -2952
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 01/05/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 01/05/2011 $12.08
Type of Use: SF Electrical
Class of Work: ALT 10 crt Branch Circuits w /Purchase 06/23/2011 $74.20
Service or Feeder
Type of Const: 0 ea 12% State Surcharge - 06/23/2011 $8.91
Occupancy Grp: Electrical
Total $195.89
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 don accordance , 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 .w re. ' -. y• - to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 01 -0010 through OAR 952-001-m190. o, obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss d By: £ ' . , r,. '— = I , Perm ittee 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 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
III g' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00004
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/05/2011
Parcel: 25111 CB05500
Jurisdiction: Tigard
Site address: 15215 SW 100TH AVE
Project: Aho Subdivision: LONDBERG MLP2000 - 00008 Lot: 2
Project Description: Upgrade existing 100 amp panel to 200 amp panel with meter replacement.
Contractor: OWNER Owner: AHO, JONATHAN E
15215 SW 100TH AVE
TIGARD, OR 97224
PHONE:
PHONE: 503 - 407 -2952
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 01/05/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 01/05/2011 $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 issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules ado• - • by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through • : r 952 - 001 -0090. You may obtain a copy of the rul: s or direct , uestions to OUNC by calling 503.232.1987 or 1.80 32.2344.
Issued By: / /_/ �_ / Perm ittee Signature: v 't
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 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.
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Electrical Permit ApplicatioECEJ`JED FOR OFFICE USE ONLY
City g of Tigard (I Received ���� Permit No.: eke,
/
a 13125 SW Hall Blvd., Tigard, OR 9722jAN 0 4 2011 Plan Review
: Date/B �- I aid, 13 - Phone: 503.718.2439 Fax: 503.598.1960 Date/13 : Other Permit: •
.t G A 1 , D Inspection Line: 503.639 CM( OF TIGARD Date Ready/13y: Juris: El See Page 2 for
Internet: www.tigard or.gov Notified/Method: - Supplemental Information
BUILDING DIVISION
TYPE OF WORK PLAN REVIEW
❑ New construction KAddition /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
X 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' - ", "1 - ",
IOOHP or more. • occupancy.
Job no.: Job site address:
is 2 t S' S w 1 , .., IsIb. 41,, ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: , , O Rt Gt 7174 ❑Health -care facilities. 0 Supply voltage for more than
L ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: , " Project name: 12 Service or feeder 600 amps or more.
l FEE SCHEDULE
Cross street/directions fo job site: i elk Q Description I QIT. I Fee. I Total
Vv New residential single- or multi- family dwelling unit.
S a-I -
- 0, N - I O 1.v .J- - S Ltd-0$ Includes attached garage.
e(
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.: 2 S ("e 6 C> S s 0 0 • Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.) .
Limited energy, multi - family 75.00 2
,^ g t ex i i7 4- I / t aA � residential (with above sq. ft.) .
3T S ervices or feeders installation, alteration, and/or relocation
Zt�v I / v V �E��11,� r 200 amps or less t 100.70 /00 70 2
X" PROPERTY OWNER ❑ TENANT 201 amps to 400 amps _ 133.56 2
401• amps to 600 amps- 200.34 2
Name: M ® N At A Ai Att ® 601 amps to 1,000 amps 301.04 2
Address: `5'. `S is (, `01 0 44/4„, Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP:
. le ii / d R , of 7 2.2 y • relocation
(CO3 Li ( ) 200 amps or less 59.36 1
Phone: �� � S a Fax:
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 :' 1 /// y_t_ 0 A. Fee for branch circuits with •
• APPLICANT SL 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: 50 - branch circuit
Each add'I branch circuit 7.42' 2
Address: ‘s . 2 . ' I ' ' • S « I40 e - Miscellaneous (service or feeder not included)
•
/ , Each manufactured or modular
City /State /ZIP:
"�'c q t ' R et 7,24 . dwelling, service and/or feeder 67.84 2
Phone: (S03) Lim 7 —213 Fax: : ( ) Reconnect only 67.84 • 2
Pump or irrigation circle 67.84 2
E - mail: 3, O I,) sat let O PK ore 4 • CAW Sign or outline lighting 67.84 2
C TRACTOR 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 (I hr min) 66.25/ hr .
City /State /ZIP: Y __ — Investigation (1 hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: ( ) ax: ( ) Inspections for which no fee is 90.00/ hr
specifically listed ('/z hr min)
CCB Lic.: Electrical Lic.: - prv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required :.. • Subtotal: l .70
Plan review (25% of permit fee): ---
Print name: • Date: ' State surcharge (12% of permit fee): 12 '0 S
. TOTAL PERMIT FEE: / / , 7 g
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 b er of inspections allowed per permit.
I :\Building\Permits\ELC- PermitAp . oc 07/01/10 440 -4615T(11 /05 /COM/WEB
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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
El 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
1:\Building\Permits\ELC- PermitApp.doc 07/01/10