Permit CITY OF TIGARD ELECTRICAL PERMIT
14 y n Permit ELC2009 -00324
2 - COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date - Issued: 06/29/2009
., ; _ Parcel: 2S103CA00204
Jurisdiction: Tigard
Site address: 11825 SW JAMES CT
Subdivision: Lot: 0
Project: Swayne
Project Description: Panel and (1) branch circuit.
1
Owner: FEES
SWAYNE, DOUGLAS H & Quantity Description Date Amount
JULIEANNA R, 11825 SW JAMES CT
TIGARD, OR 97223 1 ea Services or Feeders - 200 06/29/2009 $80.30
amps or less
PHONE: 1 crt Branch Circuits w /Purchase 06/29/2009 $6.65
Service or Feeder
1 ea 12% State Surcharge - 06/29/2009 $10.43
Contractor: Electrical
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp: R -3
Total $97.38
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 do .. . accor.- - ith 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
da =. ATTENTION: Orego law requires you to follow the rules adopted by the Oregon Utility Notification Center. Th• rules are set forth in OAR
9 - 001 -0010 through OAR 952 -10 . • i. Y- . may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1 p r , 344 .
ssued By: / / ' Permittee Signature: u .__ _ ✓.(A ■
OWNER INSTALLATION ONLY 1111 W
The installation is being made on propert 1• w_ , is n• intended for sale, lease or rent. / /� �+
OWNER'S SIGNATURE 1111 . � _ �_ .,� r iA. L (D Date: -9 L'
MI
■ ONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 ONLY
",.-----* ,
• '': City of Tigard Received ( ..e ,,,l '7
Permit No.:
q 13125 SW Hall Blvd., Tigard, OR 97223 : Review
E 3
.. '
:),' Phone: 503.639.4171 Fax: 503.598.1960
Plan
Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Suns la See Page 2 for
. TIGARD
' - Internet: www.tigard-or.gov Notified/Method: - Supplemental Information
TYPE OF WORK .-; - ;.;„,.,,,y,; - :,,,,,:- ,':- „, ,, ,,. . R Ev irE w:
. 0 New construction ,'Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
U Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
'y ' CATEGORY Or CONSTRUCTION ” ,,-. ' -..''''' 1- "---- ''' =" ' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial-use agricultural
, g1 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
,• ,,, -,- -. -,,,,,- , - .. .
_ -7: __,, , __. ._ , 7 „ , ,,,- : , , ,, .,, , 0 Emergency system. larger separately derived system.
''';`,'''r"l49B INF17-TIOIN: LOCATIONmove; 'f.; ' , f 'fi,,:zp '-- ID Addition of new motor load of
100HP or more. occupancy.
Job no.: Job site address: i i g' z.„5 s b .3 _779711(-_-,- (7 0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP:
- 1 - 7(L, i9-2D 0(2- q 7 7-03 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
1
Suite/bldg./apt. no.: Project name: 0 Service or feeder 600 amps or more.
VgEl ('"',' -:-',
Cross street/directions to job site: 1.--101:44-in • 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 145.15 4
Ea. addl 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: 2- S d.03 CA 00 ZO Limited energy, residential
DESCRIPTION OF ' , i.'1 . '.:".'''',, , ' ''' ''-,-- ,.:-:' (with above sq. fi.) 75.00 2
Limited energy, multi-family
, 75.00 2
INcb1)11.:‘ Bat7/4-LL 5i P I TC-44 1 112C&I- A-PP C,PE-(ItrE; residential (with above sq. fi.)
Services or feeders installation, alteration, and/or relocation
a-et-DILI c-4 C..- ID 001S ii) Cb i S 6OPPEL- ---) 200 amps or less 1 80.30 ? 30 2
, l'iROI'IbRO:0:4 ' . - - , , - - ' ', la TE1STANT' '' .
. ''' ,.. . .
' — 201 amps to 400 amps 106.85 2
. ,.. . ,,.. . ,, .
401
Name: amps to 600 amps 160.60 2
D 6 t
601 amps to 1,000 amps 240.60 2
Address: 1 t s -L s ..- zporrvLes - 7- Over 1,000 amps or volts 454.65 2
7 7-Z3
City/State/ZIP: 1 6 , c2_13 6Q_
Temporary services or feeders installation, alteration, and/or
A. q relocation
"
Phone: (25 ) 5 2....q 1 3.? I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation i being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, 1- .. -, en t r xc,,:: .4 4 1 -, a■ cording to ORS 447, 449, 670, and 701.
fir 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
/
Owner signature ' # , _ A, 6,, Date: (0 1 1 4 A. Fee for branch circuits with
i* , f : AD . 7 . ', In tONTAtrl ';',: ' '' - 7 above service or feeder fee, / . -..----
.6.65 6 . 4 2
each branch circuit
Business name: -
0 B. Fee for branch circuits
without service or feeder fee,
Contact name: 46.85 2
first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
90.90 2
dwelling, service and/or feeder ,
Phone: ( ) . Fax: : ( ) Reconnect only 66.85 2
E-mail: Pump or irrigation circle 53.40 2
'''CONTItACToit -=. : -,'', , - : 'K :.- '' ' Sign or outline lighting 53.40 2
Business name: 0, ( tit. Signal circuit(s) or limited-
energy panel, alteration, or
Address: / extension. Describe: Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr mm) 62.50
CCB Lic.: Electrical Lie.: Suprv. Lie.: Industrial plant per hour 73.75
ELECT:MC.4. TPERMItTEES"
Suprv. Electrician signature, required: Jc Subtotal: 96, • 9 -‘1
-P-lan-review trit-fee)i- 4
Print name: Date: -0
---?: State surcharge (12% of permit fee): I
Authorized signature: TOTAL PERMIT FEE: 9 1
This permit application expires if a permit is not obtained utithin 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
hBuilding \Permits \ELC-PermitApp.doc 05/23/06 440-4615T( I 1/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL: WORK ONLY: ,`;,,; ,' m;° x'
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
• Heating, Ventilation and Air Conditioning System*
• Vacuum Systems*
n Other:
[ :COMMERCIAL:.WORK ONLY,` t .
Fee for each commercial $75.00
system •
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \ Building \Permits\ELC- PermitApp.doc 03/23/06