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Permit CITY OF TIGARD ELECTRICAL PERMIT : - COMMUNITY DEVELOPMENT Permit #: ELC2009 -00338 T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/10/2009 Parcel: 2S102AB02402 Jurisdiction: Tigard Site address: 12501 SW MAIN ST Subdivision: Lot: 0 Project: Tigard Sub Shop Project Description: Instal 200 amp or less panel. Owner: FEES ANKELE, MARVIN R & KATHRYN J Quantity Description Date Amount 12511 SW MAIN TIGARD, OR 97223 • 1 ea Services or Feeders - 200 07/10/2009 $80.30 amps or less PHONE: 1 ea 12% State Surcharge - 07/10/2009 $9.64 Electrical Contractor: ELECTRICAL INNOVATIONS • 22300 S LEWELLEN RD BEAVERCREEK, OR 97004 -8733 PHONE: 503 - 760 -7267 FAX: 503 - 632 -6564 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $89.94 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 OAR 952-001-0100. You may obtain a copy e of f� the rules or direct questions to OUNC by calling 503.24 699 or 1.800.332.2344. W\ =7 Issued By: 1r VC 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: 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 i FOR OFFICE USE ONLY City of Tigard RECEIV -II, i " -rued �n Date/By: Permit No.:E' L l p Z O V q 0033 $ 13125 SW Hall Blvd., Tigard, OR 97223 JUL Phone: 503.639:4171 Fax: 503.598.1960 UL 0 ZOO' Plan Review Other Permit: T 1 G A R D Inspection Line: 503.639 Date Ready/B runs:fi ® See Page 2 for Internet: www.tigard -or.gov CITY OF TIGAR D otified/Method: 6 L C Supplemental Information TYPE OF WORK BUILDING DIVISION 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 ❑ 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.: I Job site address:12SC,1 ' L✓ m Al ( 100HP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: 7.1...5 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'I 500 sq. ft. or portion 33.40 I Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 .2 Limited energy, multi - family 75.00 2 residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or Tess ( 80.30 V. 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City/State / "LIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) I Fax: ( ) 200 amps or Tess 66.85 1 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. . 401 amps to 599 amps 133.75 2 Branch circuits - new, alteration, or extension, er panel Owner signature:. Date: A. Fee for branch circuits with ❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: B Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 first branch circuit Address: Each add'I branch circuit 6.65 2 Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 • E -mail: Pump or irrigation circle 53.40 2 ' CONTRACTOR Sign or outline lighting 53.40 2 t - Signal circuit(s) or limited - Business namelfle_col - v - rCca _reiv o v � ons j / energy panel, alteration, or Address:3©0 S L `( K� extension. Describe: Page 2 2 City/State /ZIP �,/C( C (I[ ) / 0 2 _ D 0 ce Each additional inspection over allowable in any of the above Per ins ection 62.50 Phone: (503) 35-7- d ' 89, I Fax ::3 ) d72 - (5 - 6 - ct p Investigation per hour (1 hr min) 62.50 CCB Liddy /Z 1 Electrical Liaa9FCI Su rv. Ic.: 1 c Industrial plant per hour 73.75 p 7��' S ELECTRICAL PERMIT FEES Suprv. Electrician signature, required .:21------ Subtotal: RD 3° Print name ty, •tIl.t.CA. Date: --/O OF— Plan review (25% of permit fee): State surcharge (12% of permit fee): Authorized signatu : TOTAL PERMIT FEE: g 9 .94 Print name: Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. • Number of inspections allowed per permit. I :\ Building \Pennits\ELC- PermitApp.doc 05/23/06 440- 4615T(II/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* O Vacuum Systems* 0 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 0 Boiler Controls ❑ Clock Systems O Data Telecommunication Installation ❑ Fire Alarm Installation ❑ • HVAC O Instrumentation - ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* O 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 I:\ Building 'Permits\ELC- PermitApp.doc 03/23/06