Permit CITY OF TIGARD ELECTRICAL PERMIT
"'7' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00294
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/02/2011
Parcel: 2S112BA08700
Jurisdiction: Tigard
Site address: 7820 SW BROOKLINE LN
Project: Tanner Subdivision: BONITA TOWNHOMES Lot: 23
Project Description: Kitchen remodel.
Contractor: KALEO ELECTRIC LLC Owner: TANNER, WILLIAM F JR
PO BOX 22104 8085 SW CHURCHILL CT
MILWAUKIE, OR 97269 TIGARD, OR 97224
PHONE: 503 - 341 -0897 PHONE:
FAX:
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 06/02/2011 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/02/2011 $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 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 sus•-nded for more the 180
days. ATTENTION: Oregon law requires you to follow the rules ado• _• by the Oregon Utility Notification Center. Those rule. - set forth in OAR
952 - 001 -0010 through OA • - 001 -0090. You ma . • . •. pv. - rules or direct •uestions to OUNC by calling 503 232.1 ••:7 or / 3
1.800.3 � .
Issued By: / �� �/ / Permittee Signat _ � Aar,-;,. —
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.
Received 51 ... c ... 2 0 City of Tigard �� DateB : / A11 Permit No.: ii Li R
III
q 1 3125 SW Hall Blvd., Tigard, OR 9 •. J * Plan Review
1 Phone: 503.718.2439 Fax 503.59 ' • .1 V i Q ` Date/By: Other Permit: m .a ( ' _ dam 4).3./ Ti G A R D Inspection Line: 503.639 �� w\\ Date Ready /By: Juris H See Page 2 for
Internet: www.tigard or.gov �� \v O' O' Notified/Method: 7i Supplemental Information
� °
YPE OF WORK O� - 01 PLAN REVIEW
❑ New construction (J Addition/alteratio0v10rient Please check all that apply (submit 2 sets of plans w /items checked below):
Q `lV' ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑Other: V 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
E 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 ", "I - ", "1 - ",
Job no.: Job site address: I A0 S 6,- , J( / t1 L I) or m or more. occupancy.
+% ` ❑ Six x or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: -"r,t 0 o� 7 ,2,.z q ❑ Health -care facilities. ❑ Supply voltage for more than
❑ 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. I Fee. I 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.)
Limited energy, multi - family 75.00 2
A /1C-0 0i1ss(ex' 4. fir .2, residential (with above sq. ft.)
Y Services or feeders installation, alteration, and/or relocation
/40114.. 12t5 L) c 1 /(;: `(. eeti 0,Qe/4 200 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: 6 :% de. I ,1 f toe 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
relocation
d 200 amps or less 59.36 1
Phone: (503) 150 '76 (s Fax: ( )
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168 54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: �/ Date: A. Fee for branch circuits with
El APPLICANT • LI CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: 6_/ � B. Fee for branch circuits without
��� e d `' le �-r� ��` service or feeder fee, first
Contact name: J/'� /47..1y, el branch circuit ,l ' 56.18 5 ' 1 2
( C
Each add'I branch circuit ,%
! 7.42 �� 2
Address: U S 3 0 s 4 r, h its Miscellaneous (service or feeder not included)
City /State /ZIP: A ;x71 t Each manufactured or modular
6 d� W ,2 6 dwelling, service and/or feeder 67.84 2
Phone: (6 ) 3 1,/ - OV 7 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
Business name: i A / 1 t panel, alteration, or extension. Page 2 2
l Each additional inspection over allowable in any of the above
Address: CA5 - 3° S 1/(T A 14 ii .-e Additional inspection (1 hr min) 66.25/ hr
f � / � Investigation (1 hr min) 66.25/ hr
City/State /ZIP:
41 ,06 C//�. 20 (9 Industrial plant (1 hr min) 78.18/ hr
Phone: (5"01 �.. (' � � 7 C &S ) Inspections for which no fee is 90.00/ hr
_ specifically listed (%2 hr min)
CCB Lic.: t f.` C Electrical Lic.: y3.. "3 Suprv. Lic.: y 0 tV ' ELECTRICAL PERMIT FEES ry
�7 7/ // �/ J /phi) 1 Subtotal:
b • '� �(
ON lg
Suprv. Electrician ure required: Plan review (25 % of permit fee):
Print name: 0.r t? 4) (. / , Date: -,Zo! ( State surcharge (12% of permit fee): 41.
TOTAL PERMIT FEE:
• Authorized signature: N,, w,d)RL` _ t `hi
1 . This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* 1 Number of inspections allowed per permit.
I:\Building\Permits\ELC- PermitApp,doc 07/01/10 440461 5T(l l /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:
❑ Audio and Stereo Systems*
n Burglar Alarm
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
El 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
El Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
n Fire Alarm Installation
El HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El 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