Permit CITY OF TIGARD ELECTRICAL PERMIT
'7 2 - COMMUNITY DEVELOP Permit # ELC2011 -00592
Date Issued 10/25/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 parcel 25111 BA01600
Jurisdiction Tigard
Site address 14405 SW 97TH AVE
Project Mitchell Subdivision CONDO SUPPLEMENTAL PLAT NO 3 Lot 32
Project Description Panel change
Contractor MARSON ELECTRIC Owner MITCHELL, MICHAEL
3825 SW 97TH AVE 14325 SW 97TH AVE
PORTLAND, OR 97225 TIGARD, OR 97224
P
PHONE 503- 620 -3203
PHONE 503 - 703 -9336
FAX 503 - 296 -4094
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 10/25/2011 $100 70
Specifics' amps or less
1 ea 12% State Surcharge - 10/25/2011 $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 perm -^fr issued sub /- to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be do in accordance with ap• •ved • s This permit will expire if work is not started within 180 da • issuance, or if work is suspended for more the 180
days ATTENTION Oregon law •unes • • o follow the rules adopted by the Oregon 4kd • ^••• Center Those rules are set forth in OAR
952 01 -0010 thn ugh OAR 952 -00 •• -0 Y• may obtain a copy of th- rules or direct questions to OUNC by calling 503 - •87 or 180033222 -4
Is ed By Permlttee Si. •ature _ tfd i rOga
—
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 INSTALL• TION•ONLY
SIGNATURE OF SUPR ELEC' / � �fr,Q� Date 7. a5� 4-
LICENSE NO /77 363
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
Received / �r� // e `/ —d `e �7
iii City of Tigard R ec e i ve �( Nunn No 0 VJ d
13125 SW I lall Blvd , Tigard, OR 97223 Plan Review
7 ' Phone 503 718 2439 Fax 503 598 1960 Date/By Other Permit
TICAaD Inspection Line 503639 Date Ready/By funs ® See Page 2 for
Internet www tigard gov Notified/Method I Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans wditems checked below)
❑ Service or feeder400 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 ',pound, or exceeds 14,000 ❑ Commercial -use agricultural
R 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 nevi motor load of ❑ "A ", "E ", `9 - ", `9 - 3,
Job no Job site address /3111 s 7 7 is 100HP or more occupancy ❑Six or more residential units ❑ Recreational vehicle parks
City /State /ZIP TI f eR> OP 'Ise ❑ I lare facilities ❑ Supply voltage for more than
❑ I lazarazardous locations 600 5olts nominal
Suite /bldg /apt no Project name ❑ Service or feeder 600 amps or more
t 7rt. tweak) FEE .SCHEDULE
Cross street/directions to job site ` K O Description Qiy I Fee I Fatal
• New residential single - or multi-family dwelling unit.
O hl Met I file.Domfte Includes attached garage.
Subdivision Lot no 1,000 sq ft or less 16854 4
Tax map/parcel no Ea add'I 500 sq ft or portion 3392 I
Limited energy, residential
DESCRIPTION OF WORK (with above 5q Ct) 7500 2
Limited energy, multi -tamily 75 00 2
residential (with above sq ft )
Services or feeders installation, alteration, and/or relocation
200 amps or less I 10070 /00
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 13356 2
/ �/ /y� !rent �/ ` 401 amps to 600 amps 200 34 2
Name
�Feg *. I7I !(V 4i 601 amps to 1,000 amps 301 04 2
Address // 434 is 5 IS 9' Over 1 000 amps or volts 552 26 2
City /State /ZIP re 44 / ®A 't'tt 1 temporary services or feeders installation, alteration, and /or
relocation
Phone 53 4u; 70,3 Fax ( ) 200 amps or less 1 5936 I 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125 OS 2
intended for sale lease rent, or exchan e, accord' g t RS 447, 449, 670 and 701E 401 amps to 599 amps 168 54 2
Owner signature Da[e.�, /t� / If Branch circuits— new, alteration, or extension, per panel
�p A Fee for branch circuits with
APPLICANT I ❑ CONTACT PERSON above service or feeder fee 7 42 2
each branch circuit
Business name B Fee for branch circuits mahout
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)
City/State/ZIP Each manufactured or modular 67 84 2
dwelling, service and/or feeder
Phone ( ) I Fax ( ) Reconnect only 67 84 2
Pump or irrigation circle 67 84 2
E Sign or outline lighting 67 84 2
ty CONTRACTOR Signal circuit(s) or limited- energy
Business name '1 AIWA \ fr q v` / \ 4• panel, a l i extension Page 2 2
3% ly AI - - l I — Or r Each additional inspection over allowable in any of the above
Address' q L 5 ,. 7 r7-- t� Additional inspection (I hr min) 6625/hr
City /State/ZIP P i 7 6_,6_, �' Y S '
Investigation (1 hr mm) 6625/hr
I Industnal plant (I hr mm) 78 t8/ hr
Phone ( ) '03'93)4 I Fax ( ^j" Inspections for which no fee is 90 00/ hr
specifically listed ('h hr mm)
CCB Lic M f 3 g I Electrical Lie 36. 4g L Supry Lic 2 e ELECTRICAL PERMIT FEES
(��J-3I/ �^Y�
'Ili / /f( ft/ ('3 Subtotal /oil• /0
Supry Electrician signature, requ'r ysmr_ r_ mn r _ Plan review (25% of pe
tfee) q
Print name I i. n.H '�� v (, ate � l" . "1 tf // State surcharge (12% of permit fee) /24
Authorized signature /—O TOTAL PERMIT FEE /� 2 .7q
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
I iauiidingiPermiisiELC-PermitApp doe 07/01/10 4404615T(11 /05 /POMM'Fa
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 B • urglar Alarm
n '',� �Sw1 •
Garage Door Opener* t
n H • eating, Ventilation and Air Conditioning System* (WAS '
n V • acuum Systems*
M A ' It `
❑ Other ii,ll1 •b ctS l i .4�31.p0'i Rh
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved: g
n Audio and Stereo Systems fre C
\O.! e t
❑ Boiler Controls , • tc @3+ tt AZAA
❑ Clock Systems
Feat wt') !,
❑ Data Telecommunication Installation
n Fire Alarm Installation
n I -IVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
Fl Protective Signaling
Fl Other
Total number of commercial systems
*No licenses are required. Licenses are required
for all other installations
1 \Buiding \Permits \PLC- PermlApp doe 07/01/10