Permit , CITY OF TIGARD ELECTRICAL PERMIT
11111 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00680
TtGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/06/2011
Parcel: 2S103CA00101
Jurisdiction: Tigard
Site address: 13185 SW 115TH AVE
Project: BRANCH Subdivision: 2008 -056 PARTITION PLAT Lot: 3
Project Description: Panel replacement and (3) branch circuits.
Contractor: FRAHLER ELECTRIC CO Owner: BRANCH, ELDON R DORIS E
11860 SW GREENBURG RD 13185 SW 115TH AVE
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 639 -4627 PHONE:
FAX: 503 - 639 -4673
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 12/06/2011 $100.70
Specifics: amps or less
3 crt Branch Circuits w /Purchase 12/06/2011 $22.26
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 12/06/2011 $14.76
Electrical
Type of Const:
Occupancy Grp:
Total $137.72
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 OA - 001 -0090. You mays' .. . t e r or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �- ��`� . � •e'rrn'ittee 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 RECEIVED FOR OFFICE USE ONLY -
_
City of Tigard Received
ate/By: , �` I. Permit No - L. i i _ a ) ' �
° 13125 SW Hall Blvd., Tioard, OR 97223 l- D E C 2 11
5 Plan Review Other Permit:
..." ; Phone: 503.718.2439 Fax: 503.598.1960 Date /B :
TIGARD Inspection Line: 503.639 CITY OF TIGARD Date Ready /By p See Page 2 for
Internet: wwv('.tigard- or.gov BUILDING DIVISIO Notified /Method: Supplemental Information
r, . , St. - ...: TXPE;eOF WORK' . .,:_, N ut .i . _. . , r 6 , , P1 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
rt5 xV• 4 ,CATECiOR OFCONSTRUCTION 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
Tr 4f1421401' ,,� - S ,� W ❑ Emergency system larger separately derived system.
�� _x`ITEIA?FOR,II ATON,0 DLOCA O -4 V;, ` ,1 ❑ Addition of new motor load of ❑ `A ", `E'', "I -2 ", '1 -3 ",
Job no.: 69010 Job site address: 13185 SW 115 AVENUE I00HPormore. occupancy.
❑ Six or more residential units ❑ Recreational vehicle parks.
City /State /Zip: - TIGARD, OR 97223 ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: BRANCH RESIDENCE ❑ Service or feeder 600 attips or m we.
Cross street/directions to job site: Description I Qty. ] Fee. I Total
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 2
' "
i I l , � DES I RtPT OF WOR ZS"Ti ' : 7r' -/1 (with above sq. ft.) 75.00
REPLACE ELEC. PANEL, INSTALL GEN. OUTLET, AC OUTLET AND 120v Limited energy multi - family 75.00 2
OUTLET IN GARAGE residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less I 100.70 100.70 2
9 W 1 v : ° I � A7 201 amps to 400 amps 133.56 2
t PR�PERF' OWNER o- ;` If 1.� TE ; .
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
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
200 amps or less 5936 1
Phone: ( ) Fax: ( ) 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168 54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
� above service or feeder fee, 3 7 42 22 26 2
f 1 ? . I ®- A PPL I CAN� , . t 1 GOt�tTACi ' . ' O t ; each branch circuit
Business name: B. Fee for branch circuits withot;
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l 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
Reconnect only 67.84 2
' Phone: ( ) Fax:: ( ) Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
i; g ''# nal circuits or limited -ener
,� .`�� <� r"��;= ��„<..._;r ., ��� ,; >'._, _�:��' �., Si g O gY
panel, alteration, or extension Page 2 2
Business name: FRAHLER ELECTRIC COMPANY Each additional inspection over allowable in any of the above
Address: 11860 SW GREENBURG ROAD Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr mm) 66.25/ hr
City /State /ZIP: TIGARD, OR 97223 Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 639 - 4627 Fax: (503) 639 - 4673 Inspections for which no fee is 90.00 / hr
specifically listed (% hr min)
CCB Lic.: 37410 Electrical Lic.: ����34 -13 /C Suprv. Lic.: S110S
nY - # F ° FLEC 41.0,0 P FLESr=_ ` ,
Su Suprv. Electrician signature, required: /_i i t . e , (� � n Su it fee : 122.96
P g q � Plan review (25 /o of permit fee):
Print name: ADAM ETHERINGTON Date: 11/29/11 State surcharge (12 % of permit fee): 14.76
TOTAL PERMIT FEE: 137.72
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
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