Permit _ CITY OF TIGARD ELECTRICAL PERMIT
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-1.11 j, . _ , COMMUNITY DEVELOPMENT Permit #: ELC2011 -00092
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/15/2011
TIGARD Parcel: 2S112BC10600
Jurisdiction: Tigard
Site address: 8256 SW MATTHEW PARK ST
Project: Benson Subdivision: MATTHEW PARK Lot: 5
Project Description: (4) branch circuits for bathroom remodel.
Contractor: CHANCO INC Owner: BENSON, BARBARA J
3521 SW CARSON 8256 SW MATTHEW PARK ST
PORTLAND, OR 97219 TIGARD, OR 97224
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PHONE: 503 - 670 -9794
PHONE: 503 - 245 -7774
FAX: 503 - 244 -4804
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 02/15/2011 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/15/2011 $9.41
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87 85
Required Items and Reports (Conditions)
This per.' is issued subjec • the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be d e in accordance with app -ved • an This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day.. ATTENTION' Oregon law r uires y.0 , to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95'- 001 -0010 thro gh OAR 952 -00 00•0. m -■ obtain a cop, of the rules or direct questions to OUNC by calling 13.232.1987 or . .332.234
, 1 l � _ � . � I
I ued By: iA / Permittee Signature: Cam_ Luigiallkit
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' -`` 41.._ I Gi ek-S Q. Date: ,// ZQ `/
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 RECEIVED FOR OFFICE USE ONLY
11, City of Tigard FEB 1 i (t it Da e/Bed . ® UGC /
Permit No.: ,, , F
ai 1312 SW Hall Blvd., Tigard, OR 9722 Plan Review
C Phone: 503.718.2439 Fax: 503 ei 8 I' t k 9( OF TIGARD Date/13 : Other Permit:
I' 1 G A R D Inspection Line: 503.639.4175 Date Ready /By: Surfs: 0 See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYP F WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
1=1 New construction ddition/alteration / replacement
❑ 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
- 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
El Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "l -3 ",
A �� ,M y �/ � / n I00HP or more. occupancy.
Job no.: ib-''! Job site address: g� r S� / rt_e . - 1 .� ❑ Six o r more residential units. P
fV� 0 vehicle arks.
City /State /ZIP: L z C ? 72 `/4 " ❑ Health -care facilities. ❑Supply voltage for more than
/// r ❑ 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. 1 Fee. 1 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 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
f .� Limited energy, multi - family 75.00 2
e ; — ( -° SI--h o -A� - r e- i _ te(c residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY 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
y 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 l ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without I
service or feeder fee, first 56.18 <• 7q/ O 2
Contact name:
branch circuit
Each add'I branch circuit 3 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State /ZIP: dwelling, service and/or feeder
Phone: ( ) I 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
/ c,, ' n J, C panel, alteration, or extension. Page 2 2
Business name:
e' '� L « / 1't , K`'y ��et% F C Each additional inspection over allowable in any of the above
Address: 36 4 / �, �� e Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: f ir -- � .. �� G�' '7 2_ i Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (J> )� CIS—') ' 7 [ L Fax: ( ) r ? 6 'et"— /Oj t( Inspections for which no fee is 90.00 / hr
/ specifically listed CA hr min)
CCB Lie. : J7/ 2_ Electrical Lic.:C ! Suprv. Lie.: lD yy ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required . 0 � n� o Subtotal:
W �n _ Ci' Plan review (25 /o of permit fee):
Print name: n sack LA ) C �� Date % (* / State surcharge (12% of permit fee): 9.€//
Authorized signature: TOTAL PERMIT FEE: , $- .g5
This permit application expires if a permit is not obtained within 180
Print name: Date: k days after it has been accepted as complete.
Number of inspections allowed per permit.
l:\Building\Permits\ELC- PermitApp doc 07/01/10 440- 4615T(1 U05 /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:
H Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n 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
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
I. \Bu ldmg\Permits\ELC- PermitApp.doc 07/01/10