Permit n CITY OF TIGARD 5: ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT r7 Permit #: ELC2011 -00589
Date Issued: 10/21/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S110BD01000
Jurisdiction: Tigard
Site address: 11925 SW BULL MOUNTAIN RD
Project: French Subdivision: SHADOW HILLS Lot: 6
Project Description: Panel change and subpanel for out building & future hot tub. 11/8/11, reprinted to add (1) subpanel, (2) feeders
and (3) branch circuits.
Contractor: NORTHWEST ELECTRICAL CONTRACTING INC Owner: FRENCH, MARGARET KAREN & ROWLAND
PO BOX 61586 11925 SW BULL MOUNTAIN RD
VANCOUVER, WA 98666 TIGARD, OR 97224
PHONE: 360 - 750 -6676
PHONE: 503 - 746 -4466
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 201 to 10/21/2011 $133.56
Specifics: 400 amps
1 ea 12% State Surcharge - 10/21/2011 $16.03
Type of Use: SF Electrical
Class of Work: ALT 3 ea Services or Feeders - 200 11/08/2011 $302.10
amps or less
Type of Const: 3 crt Branch Circuits w /Purchase 11/08/2011 $22.26
Occupancy Grp: Service or Feeder
39 12% State Surcharge - 11/08/2011 $38.92
Electrical (manual)
Total $512.87
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 i. - ccordance 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. • TENTION: Oregon - re. . -s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -01 -0010 thro gh OAR 952 -00 ' r 90. Y• • May obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 .r
Issu e d By: I rL Permittee Signature:
N. - / ....11111161111211W
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.
,� CITY OF TIGARD ELECTRICAL PERMIT
IN _ ;, • COMMUNITY DEVELOPMENT Permit #: ELC2011 -00589
TIGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439
Date Issued: 10/21/2011
Parcel: 2S110BD01000
Jurisdiction: Tigard
Site address: 11925 SW BULL MOUNTAIN RD
Project: French Subdivision: SHADOW HILLS Lot: 6
Project Description: Panel change and subpanel for out building & future hot tub.
Contractor: NORTHWEST ELECTRICAL CONTRACTING INC Owner: FRENCH, MARGARET KAREN & ROWLAND
PO BOX 61586 11925 SW BULL MOUNTAIN RD
VANCOUVER, WA 98666 TIGARD, OR 97224
PHONE 360- 750 -6676
PHONE' 503 - 746 -4466
FAX
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 201 to 10/21/2011 $133 56
Specifics: 400 amps
1 ea 12% State Surcharge - 10/21/2011 $16 03
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $149 59
Required Items and Reports (Conditions)
This permit • - • - • ect to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be done n accordance with - •proved • :. s This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days •TTENTION Oregon law - •uire- to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 -00 i -0010 thr ugh OAR 952 -00 009 -y obtain a copy' the rules or direct questions to OUNC by calling 503 232 1987 or 1 80t 332 2344
Issue. By: /` • Permittee Signature: 1gri ✓�, ,L
OWNER INSTALLATION ONLY W
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' e ,..-- 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 ,
pplication �� FOR OFFICE usE.ovLY
City
Received
IN q of Tigard Permit N
13125 SW Hall Blvd , Tigard, OR '
g .�� Date/By / o a�� / �GC � O�l d4 . .(
4:! 3 r r, Plan Review
A Other Permit
Phone: 503.718.2439 Fax: 51.! 'a \ \ . 1 � Date/By TLGARD Inspection Line: 503 4175 Cl .9 ` Date Ready /By Suns ® See Page 2 for
Internet. www.tigard- or.gov � ` GQ► 5 Notified/Method Supplemental information
, / TYPE OF WOR Q � � �� PLAN REVIEW
❑ New construction [J Addition/alterat 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: , Q)\ 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 El 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 ", "l -2 ", "I -3 ",
Job no : Job site address: 1 11 Z5 54.3 'Butt rl/t,{n RA I xxHP or more occupancy
❑ Six or more residential units ❑ Recreational vehicle parks.
City/State /ZIP: % w
`e4 62 I ?ZZL, ❑ 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
DESCRIPTION OF WORK (with above sq ft) 75 00 2
4' I I'^^ Limited energy, multi - family 75 00 2
Pal() , t � c kam C� e 1 -t ga pa/vi GI 1 r residential (with above sq ft )
s /1 Services or feeders installation, alteration, and/or relocation
OW. IQ/,�; ,IC(4;M 4? Tye I/(),t t "I"L(, 200 amps or less 100 70 2
E MOPERTY OWNER ` ❑ TENANT 201 amps to 400 amps ! 133 56 ii 3"3.51; 2
'AA 401 amps to 600 amps 200 34 2
V
Name: Vl , yeti 1 , � e /^
601 amps to 1,000 amps 301 04 2
Address: (I q ZS JW I3 .a Vv1. f 21 J Over 1,000 amps or volts 552 26 2
O �� Temporary services or feeders installation, alteration, and /or
City/State /ZIP:
relocation
Phone: (503) 744,. 4440 (,, 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, ren or exchange, a ording to O' S 447, 449, 670, and 701. 401 amps to 599 amps 168 54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: ■ 40f.i _ ..11A /Z / Date: A Fee for branch circuits with
❑ APPL ANT , ❑ 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'I 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:
Signor outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: panel, alteration, or extension Page 2 2
�o 1`T4 �Le i _ E(..L (AL. C DL AC i 1 4_ Each additional inspection over allowable in any of the above
Address: I> ,, t L (' %t_e Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr min) 66 25/ hr
City /State /ZIP: (.).6i_, couvck, (.-___) CISSWt. Industrial plant (1 hr min) 78.18/ hr
Phone: ( - j ) '. X50 - taco — 4C.o Fax: ( ) � i 1f Inspections for which no fee is 90 00/ hr
.q specifically listed (%z hr min)
CCB Lic.: 1 /e Electrical Lic.: �7�5� G Suprv. Lic.: �� ELECTRICAL PERMIT FEES fl
Subtotal: in
Suprv. Electrician ` l ectrician signature, required: 3 �_ ���`_. Plan review (25% of permit fee)
Print name: P Date: State surcharge (12% of permit fee) (( , 0
TOTAL PERMIT FEE I tie' .. .5 A ry70 Authorized signat :I j , J This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: t N tw I�xC F-- tid tS Date: )l7 . h I C • Number of inspections allowed per permit
I.\Buddmg\Permits\ELC -Per p doe 07/01 /10 440- 4615T(I 1/05 /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:
n Audio and Stereo Systems*
n Burglar Alarm
,
H Garage Door Opener*
H 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) • . a
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems '
H Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
H Medical
H Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 \Buddmg\Permits\ELC- PermitApp doc 07/01/10