Permit 1 1 1 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00069
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/28/2011
Parcel: 2S111DD02500
Jurisdiction: Tigard
Site address: 8900 SW HAMLET ST
Project: Steagall Subdivision: STRATFORD Lot: 33
Project Description: (3) branch circuits.
Contractor: OWNER Owner: STEAGALL, JARED
8900 SW HAMLET ST
TIGARD, OR 97223
PHONE:
PHONE: 503 -319 -7960
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 01/28/2011 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/28/2011 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 isi suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules - • • • - • the Oregon Utility Notification Center. Thos -' rules are set forth in OAR
952- 001 -0010 through A: •52 -001 -0090. You may obtain a copy of th- ules or direct que .tions to OUNC by calling 503.232.1987 or-1402632.2344.
Issued By: _ _ I'� Permittee Signature: C
WNER 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.
Electrical Permit Application -s , FOR OFFICE USE ONLY
City of Tigard :. �� Received Permit No ,
r1 Date /By: MUM= lt..(� to _ow
I P/
- " 13125 SW Hall Blvd., Tigard, i'7..! : ' 3 �� �� Plan Review
�', Phone: 503.718.2439 Fax 503:"' 98.19 Other Permit:
` � '�� Date /B
TIGARD Inspection Line: 503.639.4175 , �fj. \ `'' Date Ready /By: H See Page for
Internet: www.tigard-or.gov r�` Notified/Method rE� Supplemental Information
r TYPE - OT+ WOR1�' {�4 1 � 'a 3 yg '' 3 t PPTAN REVIEW r r,
,a '..,. ....A �� yam'~ .. .._ 3., z.`fw�3 ;a.. *' ., ..,.m'.*,_, /.,
❑ New construction ® Addition /alterati d. eplacement 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.
l V CATEGORY OT 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
�° rtw ❑ Emergency system. larger separately derived system.
Ia f JOB SITE I' 'FORM 1 TIONrANDg�LO - � . ❑Addition of new motor load of ❑ "A" "E" "1 2" "1 -3"
Job no.: Job site address: 8900 SW Hamlet St. I00F1P or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard / OR / 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Steagall Improvements ❑ Service or feeder 600 amps or more
street/directions to job site: Hall Blvd. ,. .`EEiF. SGIIEDULE y { ,
Cross street/directions
J Description I Qty. I 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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no 2S1 11DD02500 Limited energy, residential
it 1 ,11t DEtSCRIP71* �®R�� WORK _ (with above sq. ft.)
75.00 2
Limited energy, multi- family 75.00 2
1.)Installed 1 new branch ciruit for main kitchen can - lighting. residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
2.)Alteration to 2 different circuits by adding can lighing, ceiling fan, outlet 200 amps or less 100.70 2
H a g1401ERT*�X OWNER f TENANT ` 201 amps to 400 amps 133.56 2
,... .�, .n. .. .. � _..._a_ ., ..�� ,��. ., �,„ _ .. .,.��, .;� afvfr .w.rm. ,`wry
Name Jared Steagall 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 8900 SW Hamlet St. Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: Tigard / OR / 97224 relocation
Phone: (503)319 -7960 Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation being made on property that I own which is not
intended for sale, lease, rent, or_e 0- . nge, 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: _ Zef //( A. Fee for branch circuits with
above•service or feeder fee, ,
®- APP . ANT�� �, 4 ' CONTACT ^PESON
/ p r ��.t. _ _�'�, s 1 ,, .. .w R each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first G
Contact name: Jared Steagall branch circuit 56'18 t i 0 2
Each add'I branch circuit V ... 7.42 77, F 1 1 2
Address: 8900 SW Hamlet St. Miscellaneous (service or feeder not included)
Cit City/State/ZIP: Tigard / OR / 97224 Each manufactured or modular
Y g dwelling, service and /or feeder 67.84 2
Phone: (503) 319 - 7960 Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E Steagall@tecIde.com Sign or outline lighting 67.84 2
5 CONTItAC�TOR t r
,�:• v� .� .. tea` a .`, ��4�� .��.�, .,� � ..0- -� -- �.. "�_. `• •. 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: 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 Lie.: Electrical Lie.: Suprv. Lic.: MilllriaalittOitatitE4.8ftliftiMM1110117
Suprv. Electrician signature, required: Subtotal Eg,ii
—
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): t! ` j`}.,
TOTAL PERMIT FEE: f
Authorized signature: 7� i
g 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.doe 07/01/10 440- 4615T(11/05 /Coal /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
`RESIDENTIAL WORK ONLY 3
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAIRWORK ONLY
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n 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- PermitApp.doc 07/01/10
i
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 I 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.
------%, flPtiet 1 1
Print Name of Permit pplicant
Si ature of Permit ' pp cant Date
Permit #: _ CL. -C- 2-p f - i q .
Address: t`/D S 641f �' `,
Issued by: ° /,' Date: al_ 1/5://4_____
This Copy for Permit Offices