Permit �� CITY OF TIGA ELECTRICAL PERMIT
" ' ' r • . 4. ' COMMUNITY DEVELOPMENT Permit #: ELC2009 -00430
TiGA RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/19/2009
Parcel: 2S111DCO2300
Jurisdiction: Tigard
Site address: 15785 SW ALDERBROOK CIR
Subdivision: SUMMERFIELD NO.8 Lot: 470
Project:
Project Description: Replace 200 amp /less panel.
Owner: FEES
WALL, PHYLLIS A TR & Quantity Description Date Amount
FRYE, PAMELA SUE TR, 15785 SW
ALDERBROOK CIR 1 ea Services or Feeders - 200 08/19/2009 $80.30
amps or less
PHONE: 1 ea 12% State Surcharge - 08/19/2009 $9.64
Electrical
Contractor:
EASTGATE ELECTRICAL INC
P.O. BOX 30581, SUITE 206
PORTLAND, OR 97296
PHONE: 503 - 252 -8910
FAX: 503- 252 -5317
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
• Total $89.94
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 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 O' R 952-001 -0100 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
pp 7 , '
Issued By: 4 OWNER INSTALLATION ONLY \ � �' � � � �..�L ., ., Perm ittee Signature: i
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 an inspection that business day.
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
r� '
City of Tigard ' ° " "' � ateB� PermitNo.: l(� ` l �� �.G(J
0
y: ��Q N
13125 SW Hall Blvd., Tigard, OR 97223 AU 9, 20 'Ian Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 Date/13y:
Mill Inspection Line: 503.639.4175 ��� ate Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov CITY " ottfied/Method: I Supplemental Information
� I11It`at iv
TYPE OF WORK t ' ' ' ,. a 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. A
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "] -3 ",
IOOHP or more. occupancy.
Job no.: Job site address:
1S 85 sa) A Lnftt BRao$ e ta. ❑ Six or more residential units ❑ Recreational vehicle parks.
City /State /ZIP: /► ® (� ❑ Health -care facilities. ❑ Supply voltage for more than
Ti V I�.y+ CA ` ❑ 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. J Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
A /�- 1A • /I,/ , t C Limited energy, multi - family
,W
R Pt A ejr � L. r L re. 7 Q e+71. P» L residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 80.30 A) 30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 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, 6.65 2
Business name: each branch circuit
�S 7 _ 4 .. 7 ( £L lw L � B . Fee for branch circuits
�� C without t branch service c u feeder fee,
Contact name: 46.85 2
.Tt7u eGL first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: i4s7 G A, T4 ..ALE TP.L C Signal circuit(s) e r limited -
/�1 G C energy panel, alteration, or
extension. Describe:
Address: / a 3a. 30 s ibe: Page 2 2
City /State /ZIP: p U D r 4. N
AA / U Cl (, & 9 ? a Each additional inspection over allowable in any of the above
(� Per inspection 62.50
Phone: (610 ) 2 r3 • ?li /U Fax: ( ) 52. -- S? / ? Investigation per hour (1 hr min) 62.50
CCB Lie.: £13 I 1 Electrical Lic. _1 Suprv. Lie.: `s` Industrial plant per hour 73.75
11.14 4 0 ?• t . 1 a .S , t, t o ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: eieylot? Subtotal:
Print name:-7' � 1 q /�,Q is l L Date: B �`7_ U t Plan review (25% of permit fee): ' Gy
`S ' C� State surcharge (12% of permit fee):
Authorized signature: Seikietfto TOTAL PERMIT FEE: 3 9 Q4
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per pennit.
I.\Building\Permits\ELC- PermitApp doe 05/23/06 440- 4615T(1I /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*
❑ 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:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
•
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ 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 03/23/06