Permit CITY OF TIGARD ELECTRICAL PERMIT
• 1 11- ;' COMMUNITY DEVELOPME Permit #: ELC2012 00031
Date Issued: 01/18/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S134CA00509
Jurisdiction: Tigard
Site address: 11055 SW 119TH AVE
Project: Geist Subdivision: PANORAMA NO.2 Lot: 20
Project Description: (2) branch circuits for water heater and fireplace fan.
Contractor: OWNER Owner: GEIST, DENISE E & DANIEL J
11055 SW 119TH AVE
TIGARD, OR 97223
PHONE:
PHONE: 503 - 853 -4532
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 01/18/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/18/2012 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
•
Total $71.23
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 accord ' h-4..uroved 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. ATTENT : Oregon law, requ' u follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 ro gh OAR 952 -001 O. Y m obtain a copy oft a rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332 344
Issued By: Permittee Signature: \C I -.A.A./
OWNER INSTALLATION ONLY
The installation is being made on propert I own whicji is not intended for sale, lease or rent.
OWNER'S SIGNATURE .eLIL.-1 / Date: V/���
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.
RECEIVED
Electrical Permit FOR OFFICE USE ONLY
I,4N 1 8 2012 Received
lig City of Tigard Date/By: / /V /2- / PermitNo.: 6te 1.45/o?-
° 13125 SW Hall Blvd., Tigard, O,R 2A Plan Review
(( gC g� Date/By: Other Permit:
Phone: 503.718.2439 Fax: 5 1 TIG ARD
Inspection Line: 503.639.41' ILDING DIVISION Date Ready/By: Juris: ® See Page 2 for
- T I G A ' RD ' N otified/Method: Supplemental Internet: www.tigard- or.gov pp emental 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 O F 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 ❑ 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 - ", "l - ",
> IOOHP or more. occupancy.
Job no.: Job site address:
// 5 / / !v ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: 6 frizo O , 2:2-3 c 7 z3 ❑ Health - care facilities ❑ Supply voltage for more than
f ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: G . / £'T ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I 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'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
Limited energy, multi- family 75.00 2
A00 DI D (C,9-y D oiz - -► / r 6 f { i./-7- /C. 6f (f/}kQ th9 residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
/4 L _ g i i - j C ( - / C . / i c Li-- e r 7 , 0 0 , p o L 7j / I Q Plsa !7i✓ 200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 161 N L.).4. �. 6e/sr- 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: / £ Q S ,- .SZ-Ar /) 1 A- ,4 Over 1,000 amps or volts 552.26 2
City /State /ZIP: cf/ P__t� 6Y` Temporary services or feeders installation, alteration, and /or
( relocation
Phone: ( 9 .7 ) es? Z 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, le , rent, or ex h ge, according t ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
a
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: / — / tf' 1 1 -- 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 j 56.18 56./t 2
Contact name: branch circuit
Each add'I branch circuit 1 7.42 - 7.42 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 67.84 2
lli
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E
Sign or outline lighting 67.84 2
CONTRACTOR '
Signal circuit(s) or limited- energy
Business name: D( ) /0 4 panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66 25/ hr
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (%z hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: o Subtotal: CD 3 •/Po
Plan review (25% of permit fee): ------**
Print name: Date: State surcharge (12% of permit fee): _ 7.0
\ t i , e- �� TOTAL PERMIT FEE: 7 ( . 3
Authorized signature: F /�1 /� t�
This permit application expires if a permit is not obtained within n 180
7 Date: / v days after it has been accepted as complete.
Print name: lc / ,J (F' L U . Gc t sr- / —/ d , /7___ Number of inspections allowed per permit.
I \Building5Permits\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:
❑ Audio and Stereo Systems*
❑ 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
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
. ❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ 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.\Budding\Permits\ELC- PermitApp.doc 07/01/10