Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00574
Date Issued: 10/18/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S103AD06100
Jurisdiction: Tigard
Site address: 12635 SW 111TH PL
Project: FILLHOUER Subdivision: WILDERNESS Lot: 7
Project Description: Panel replacement
Contractor: ALLIED ELECTRIC Owner: FILLHOUER, RONALD M
PO BOX 1640 12635 SW 111TH PL
NORTH PLAINS, OR 97133 TIGARD, OR 97223
PHONE 503 - 614 -8000 PHONE'
FAX 503 -614 -1186
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 10/18/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 10/18/2011 $12 08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112 78
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 OAR 952 - 001 -0090. You may obtain a copy of the - or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By: L _ .. Permittee Signature:
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 OFFIC USE o w ,
Cit Tigard RECE
C i of e°eived !
'' _ » ate /B 1 �I Permit No �` '�tI 7
' . ° 13125 SW Hall Blvd ,Tigard, OR 97223 Plan Review
Phone 503 718.2439 Fax: 503 598.1960 �f Date/By Other Permit
TI,G'A1tD inspection Line: 503 639 4175 OCT 1 7 2011 Date Ready/By Juris EY See Page 2 for
Internet: www tigard or.gov Notified/Method ZO Supplemental information
CITY Cr TI" A S"
I I 1 1.J
TYPE OF W PLAN REVIEW
[3! i ll D J t'l51 C't�,M
" 5 '"J' i v Please check all that apply (submit 2 sets of plans w /items checked below).
❑ New construction �. Addition /alteration�ep'lacemen
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: where the available fault current ❑ Mannas 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
ig1- 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
f a CI Addition of new motor load of ❑ "A ", "E ", '1 -2 ", "1 -3 ",
Job no.: Job site address: /2,6,35' Err / ` i 1 I ❑ Six xHP or more occupancy
ix or more residential units ❑ Recreational vehicle parks
City /State /ZIP: ' i A'f'L- Ca- ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite /bldg. /apt. no : Project name: c' '1 I /I OlA ❑ Service or feeder 600 amps or more
r ' 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
DESCRIPTION OF WORK (with above sq. ft) 75 00 2
n Limited energy, multi - family 75 00 2
1 L ' " / —e-, residential (with above sq ft )
U Services or feeders installation, alteration, and /or relocatip
fo 1l91f/Z b/ZCEt./ / -Fii— 200 amps or less t 100 70 00 / 2
❑ PROPERTY OWNER ❑ TENANT 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
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
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
❑ APPLICANT ❑ 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)
Ctt /State /ZIP: Each manufactured or modular 67.84 2
y 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
CONTRACTOR Signal circuit(s) or limited- energy
Business name' Q (v L C �� �, (
JJ -: . panel, alteration, or extension Page 2 2
/T — Each additional inspection over allowable in any of the above
Address 742L9 4�'' /64 /t) Additional inspection (I hr min) 66 25/ hr
City /State /ZIP: I t�� 04
Investigation (1 hr mm) 66 25/ hr
r `G� I industrial plant (1 hr min) 78.18/ hr
Phone. ' s'"" -' Inspections for which no fee is
( )� kC'r Fa ( ) ��� ���L 90 00/ hr
specifically listed (% hr min)
CCB Lic.: •.'f Electrical Lic.: /f ?{ Suprv. Lic.: . 3f95 5 ELECTRICAL PERMIT FEES
0 2, ( -711 WI �� 3 Subtotal. 4 cic , fit?
Suprv. Electrician sig tur , equired: i�t
Plan review (25% of permit fee) `,�
Print name: QbN N t•'� / a / /� � r� Date: /O//'7// State surcharge (12% of permit fee) 1 2_ --
TOTAL PERMIT FEE / / 42 r 7 es
Authorized signature -
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 permit
1 \i5uilding\Permits\ELC- PermitApp doc 07/01/10 440- 4615T(I1 /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
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ 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
n HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 \Budding\Permits \El.C- PermttApp doc 07/01/10