Permit •
CITY OF TIGARD ELECTRICAL PERMIT
Ili '` COMMUNITY DEVELOPMENT Permit #: ELC2011 00637
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/10/2011
Parcel: 2S109AB05000
Jurisdiction: Tigard
Site address: 14167 SW 133RD AVE
Project: BRENNAN Subdivision: THREE MOUNTAINS ESTATES Lot: 43
Project Description: Electrical for interior remodel.
Contractor: KODIAK ELECTRIC, LLC Owner: BRENNAN, MARK D & LAURA M
8486 SUNNYSIDE RD 14167 SW 133RD AVE
SALEM, OR 97306 TIGARD, OR 97224
PHONE: 503 - 881 -1259 PHONE:
FAX: 503 - 391 -2611
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo /Purchase 11/10/2011 $93.28
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/10/2011 $11.19
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $104.47
Required Items and Reports (Conditions)
This perm - • - bject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and = • her applicable law. All work will
be d• - in accordance wi approve. plans. This permit will expire if work is not started within 180 days of issuance, • if , ork is suspended for more the 180
day -. ATTENTION: Oregon :w equ e: •u to follow the rules adopted by the Oregon Utility Notification Ce' er. Tho rules are set forth in OAR
95 thr•ugh OAR 952-%11-0091 You ay obtain a copy of the rules or direct questions to OUNC by calling 503.232./: or :1 32.2344.
I.sued 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: /( /#4
LICENSE NO. 57/ 35
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 OFFICE. USE ONLY. .. .. _
City of Tigard
Received �L j/ � OZ!9 i 3 ' 7
Date/By: Re view
Plan 1.) n / Permit /
III
° 13125 SW Hall Blvd., Tigard, OR 97223 Review
C • Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Pennit:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: lurk la See Page 2 for
Internet: www.tigard - or.gov Notified/Method: T j1 Supplemental Information
TYPE OF WORK 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
NI 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 new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: / 2 ",' 7 j r � /33 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks
City/State /ZIP: -rr> wy o b /2— ❑ Health -cafe facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: 0 0 pt N ) ❑ 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 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
/� / Limited energy, multi - family
6 C 1 / V f ,,Le /4 A b 4 residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 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 co ./9 2
Contact name: �/
branch circuit
56.18
Each add'l branch circuit 5- 7.42 ell/ • ' 3
Address: Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 67.84 2
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: /1z 0 /'/ ..e / � c panel, alteration, or extension. Page 2 2
/ Each additional inspection over allowable in any of the above
Address: g f' d b 5,,,,,,y,.<, h,2 / �, , p Additional inspection (1 hr min) 66.25/ hr '
/ 4 (1 hr min) 66.25/ hr
City/State /ZIP: 4- /E74 0 ,e e-
Industrial plant (1 hr min) 78.18/ hr
Phone: (127?) 86Y /2,5-7 Fax: (03 ) ,/ — 2( // Inspections for which no fee is
specifically listed (%3 hr min) 90.00 / hr
CCB Lic.:l ( l ? Electrical Lie.: Z y',528 C Suprv. Lic.: j //3-5 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 44/ : ��� p3+�
'/ Plan review (25% of permit Subtotal fee): _A q
Print name: 741,1 h- Date: 7/-7/11 State surcharge (12% of permit fee): l X.-4 11. �/
TOTAL PERMIT FEE: j44-
Authorized signature: �
Print name: ,
This permit application expires if a permit is not obtained within II�,O't
h C Date: / / / f J / days after it has been accepted as complete. (p `
// / r/ * Number of inspections allowed per permit.
P\Building\Permits\ELC- PermitApp.doc 07/01/10 440-46 15T( 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:
El Audio arid Stereo Systems*
❑ Burglar Alarm
n G • arage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n V • acuum 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
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑' Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n 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:t BuildingPermits \ELC- PermitApp.doc 07/01/10