Permit r : ,, CITY OF TIGARD ELECTRICAL PERMIT
R - ::- COMMUNITY DEVELOPMENT Permit #: ELC2011 -00351
•
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/24/2011
. Parcel: 2S 114BB20200
Jurisdiction: Tigard
Site address: 16545 SW 103RD AVE
Project: Holmes Subdivision: RIVERVIEW ESTATES NO. 2 Lot: 46
Project Description: (1) branch circuit for A/C
Contractor: ENGELMAN ELECTRIC INC Owner: HOLMES, ANDREW
PO BOX 451 16545 SW 103RD AVE .
HUBBARD, OR 97032 TIGARD, OR 97224
PHONE: 503 - 981 -8041 PHONE:. 503 - 430 -7239
FAX: 503 -981 -4026
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 06/24/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/24/2011 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oft 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 suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through 0 95 - 90 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: Permittee Signature: 6 fr��U' "
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.
..,06/24/2011 11:35 50395140 ENGELMAN ELECTRIC PAGE 02/02
Electrical Permit ApplicatioiRECE�� A V ED FOR OFFICE. USE ONI.V
City of Tigard Received aet: D a 3S
W g U N 2 4 2011 Date/B •: ' // 47.4i, Pendit No.: r
a 13125 SW Hall Blvd., Tigard, OR 9722 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Pern#7 // .---e,/ Q2 9
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: FM Ea See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK c , '" '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.
El Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
excee 10 amps at 150 vo lts or ❑ Floating buildings.
CATEGQlii' OF . ... . . TICTION .. 0 Commercial-use agricultural
_ less to ground, or exceeds 14,00 � • _ � - • ❑ Commercia a •ri
® 1- and 2- family dwelling El Commercial /industrial ❑ Accessory building amps for all other installations, buildings.
❑ Multi - family El Master builder ❑ Other: e system
❑F ire pump. Installation of 75 KVA or
30 ... Emergency cyst m. larger separately derived .
B SITE I N O RMATION AND tLOCATION
❑ Addition of new motor load of ❑ "A ", "E " "1 -2 ", "1.3 ",
Job no.: 23799 Job site address: 16545 SW 103 AVENUE 100HP 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: WOLFER'S /ANDREW HOLMES ❑ 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'l 500 sq, ft, or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
7500 2
•t :DESCRIPTIONOF WORK (with above sq. ft)
Limited energy, multi- family 75,00 2
WIRE FOR 3 TON A/C residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
.o • PROPERTY OWNER - 0 TENANT r. >' 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
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: 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
•... 1 .. • - :, above service or feeder fee
III ! ® CONTACT PERSON 7,42 2
each b ran c h c
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: branch circuit
Each add'l branch circuit 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: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
rCQNTRA •• Signal circuit(s) or limited- energy
Business name: ENGELMAN ELECTRIC INC panel, alteration, or extension. Page 2 , 2
Each additional inspection over allowable in any of the above
Address: P 0 BOX 451 Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: HUBBARD OR 97032 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
hone: (503 981 - 8041 Fax: ) 98 026 Inspections no 503 Ii for which fee is 90.00 / hr
Fax: (
503) pv specifically Sisted (' /, hr min)
CCB Lic.: 94581 7 Electrical Li " 24 -46C x/ ' Suprv. Li • E`.'. ELECTRICAPERMIT FEES Subtotal: 56.18
Suprv. Electrician signature, required: = ^ Plan review (25% of permit fee):
Print name: RON THUNDERBIRD Date: 06/24/11 State surcharge (12% of permit fee): 6.75
TOTAL PERMIT FEE: 62.93 .,
Authorized signature: 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.
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