Permit CITY OF TIGARD ELECTRICAL PERMIT
111 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00087
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/10/2011
Parcel: 2S103DA02400
Jurisdiction: Tigard
Site address: 10820 SW DERRY DELL CT
Project: Brown Subdivision: DERRY -DELL NO. 2 Lot: 26
Project Description: (1) service and (2) branch circuits.
Contractor: MCCAMMON ELECTRIC CORP Owner: BROWN, HUBERT A
5086 IKE MOONEY RD PO BOX 1997
SILVERTON, OR 97381 WILSONVILLE, OR 97070
PHONE: 503 - 435 -7583
HONE: 503 - 559 -8466
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 02/10/2011 $100.70
Specifics: amps or less
2 crt Branch Circuits w /Purchase 02/10/2011 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 02/10/2011 $13.86
Electrical
Type of Const:
Occupancy Grp:
Total $129.40
Required Items and Reports (Conditions)
This permit is iss _ -d 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 accordance wi • •roved p -ns. 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 e• •ire- yo to follow the rules adopted by the Oregon Utility Notificatio enter. Those rules are set forth in OAR
952 '01 -0010 through OAR 952 -001 - b • 0. o may •btain a copy of the rules or direct questions to OUNC by calling 5 .232.1 87 or .800.332.2
, I -ued By: .� il/ v .� : Perm ittee Signature: / NC � �l /�fi
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
I
SIGNATURE OF SUPR. ELEC' �, >>f1/ ,i 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 FOR OFFICE USE ONLY /f/
City of Tigard )� Date /B : , r .1/ Permit No.: ekCA011-"` I v 7
13125 SW Hall Blvd., Tigard, OR 97223 � j Plan Review
II ■ Phone: 503.639.4171 Fax: 503.598. �'" Date/By: Other Permit:
I' 1 c. A R D Inspection Line: 503.639.4175 Date Ready/By: ion -. ® See Page 2 for
Internet: www.tigard- or.gov 0 Notified/Method: Jy 6 Supplemental Information
1‘C) - \p�
TYPE OF WORK 0 c � , PLAN REVIEW
❑ New construction ,fddition/alteration / repll
t om ` 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 0 Other: ;�° ' ' where the available fault current 0 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: /1) ` /' / 100HP or more. occupancy.
` lJ ( I � � �I �� ❑S ix or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: '1'- ❑ Health -care facilities. ❑ Supply voltage for more than
1 . , / �/ 111fff ❑ 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: q 1 c., 1 fi e ,, , f ' f -� Pair k.._ Description I Qty. I Fee. I Total I *
t ✓ ti "` New residential single- or multi- family dwelling unit.
/4. k - T- aA. Pet.v k k l jteCt— o✓k Dewy [ I . Includes attached garage.
Subdivision: pc.
ot 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 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less i 100.70 ((k) 770 2
A' PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
r 401 amps to 600 amps 200.34 2
Name: I)ei
i/1 601 amps to 1,000 amps 301.04 2
Address: i b g 0 D ,-r D .,1i' et- Over 1,000 amps or volts 552.26 2
V Temporary services or feeders installation, alteration, and /or
City/State/ZIP:
-r�� q al. c r relocation
Phone: (�' 3) !� 3 5 ....75g Fax: ( ) 200 amps or less 59.36 1
JJJJ 201 amps to 400 amps 125.08 2
Owner installation: This installation is E7ng 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 r 7.42 7 $.1 2
each branch circuit
Business name: L B. Fee for branch circuits without
k (i service or feeder fee, first 56.18 2
Contact name: a V j` vVl branch circuit
�.` v,� � �,/ E ach add'l branch circuit 7.42 2
Address: .�0' ^ � � — A o� `� r` Miscellaneous (service or feeder not included)
t3 ♦ t1/4/(tv 7 1
City/State/ZIP: / v` r Each manufactured or modular
dwelling, service and/or feeder 67.84 2
5 7) 5E � �� I ( ) Reconnect only 67.84 2
Phone: 7 Fax:
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
L panel, alteration, or extension. Page 2 2
Business name: A4 � W1- I1 E l 'e T- I � Each additional inspection over allowable in any of the above
Address: 50 S� ��E •, 1 1 ' Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: i `0 7 3 g J Investigation (1 hr min) 66.25/ hr
' 4 "V g 1 Industrial plant (1 hr min) hr 78.18/ hr
Phone: ) { ' ' � Fax: l / / Inspections for which no fee is
(� �� fa P �� I/ ' specifically listed (%z hr min)
CCB Lic.: JL/ J 210 Electrical Lic.: l Suprv. Lie.: £4 2164; ELECTRICAL PERMIT FEES
Suprv. Electrician signatu , required: t90.00 / �5; �'f
,� �� �
_ ��/yQ Plan review (25% of permit fee) :
Print name: ' , I 1 Date 2 _ ` . _, / State surcharge (12% of permit fee): / 3 r '
TOTAL PERMIT FEE: / »i , 1 1.0
Authorized signature. 7 c_
` �� l y y ,, This permit application expires if a permit is not obtained within 180
Print name: � A i / i r , t �. � days after it has been accepted as complete.
CL C ` wig Date: 2. -� �l * Number of inspections allowed per permit.
I:'Building\Permits\ELC- PermitApp.doc 07/01/10 440- 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*
n Heating, Ventilation and Air Conditioning System*
H Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
H Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
H Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
H Outdoor Landscape Lighting*
n 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