Permit p CITY OF TIGARD ELECTRICAL PERMIT
11111 $ COMMUNITY DEVELOPMENT Permit #: ELC2011 -00128
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/08/2011
E G AR LS Parcel: 1 S136CD01400
Jurisdiction: Tigard
Site address: 11654 SW PACIFIC HWY 10A
Project: D & R Heating & Air Subdivision: Lot: 0
Project Description: Electrical reconnect.
Contractor: Owner: MASSIH, ABBAS
0836 SW CURRY ST #400
PORTLAND, OR 97239
PHONE:
PHONE: 503 - 246 -5555
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 03/08/2011 $67.84
Specifics:
1 ea 12% State Surcharge - 03/08/2011 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Cod:- a - •er ap- icabl: law. All work will
be done in ance with a• • ove• < ans. This permit will expire if work is not started within 180 days of issua r if is s spen•-ed for more the 180
days. A NTION: Oregon law equir • yo o follow the rules adopted by the Oregon Utility Notification a er. i os- r es =re set forth in OAR
952 -00 -0010 thro gh OAR 952- 0�•09 ay •btain a copy of the rules or direct questions to OUNC by calling 503. 87 or 1/ s • •2. , 44• .
I
Is ed By: — _ .1 �! /� � Permittee Signature: i / / 4
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.
Electrical Permit Application FOR OFFICE USE ONLY
114 City of Tigard Rey. Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
g Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
1 1 ; ,\ it i 1 Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Paget for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK 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: // L f___'-, /1 ( 100111 or more. occupancy.
/ (o G� 0� �/ L / ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: �� 7 A el �+ Gj > a CI Haz d ouse o c a ti o n s. . ❑ Supply voltage for more than
e ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: l Q n Project name: en "1 ,k � 4 cor- 0 Service or feeder 600 amps or more.
–
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
iiGt-'€. - ;14/ die r ,/f 01=1=
/ /- G Ma /`j /7 `e tai residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
S? e C F i v4 .6 Z P ( I € C l-70 y) • 200 amps or less 100.70 2
[PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: fi f::5 ,_h/ 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: / y / b / / 4 A C / 4 r 1� L ,J% Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: t
'/' 1 C « (}' 0 7 2 Z 3 relocation
Phone: ( a Ll 6 – s S5 Fax: ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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, er panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ 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: 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
dwelling, service and/or feeder
Phone: ( ) Fax:: ( ) Reconnect only 67.84 (o 7, 8e{ 2
Pump or irrigation circle 67.84 2
E - mail:
Signor outline lighting 67.84 2
CO CTOR 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/ lr
-
Industrial plant (1 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: jp7, SSA
of permit fee):
Print name: Date: State Plan surcharge review (12% (25% of permit fce): -- till
t(
TOTAL PERMIT FEE: `76 .9 8
Authorized signature:
/I • This permit application expires if a permit is not obtained within 180
Print name: D y‘;',6/1 days after it has been accepted as complete.
�d /�� 1! �r--1 iJ� / N um b er o inspections allowed per permit.
I :\ Building \Pmmits\ELC- PermitApp.doc 07/01 /10 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*
n 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
n Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: 1Buitding \PermitskELC- PermitApp.doc 07/01/10