Permit CITY OF TIGARD ELECTRICAL PERMIT
.71
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00166
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/23/2012
Parcel: 1 S134AD01000
Jurisdiction: Tigard
Site address: 11386 SW IRONWOOD LP
Project: HERR Subdivision: ENGLEWOOD Lot: 29
Project Description: Panel replacement.
Contractor: OWNER Owner: HERR, CURTIS OMER
11386 SW IRONWOOD LP
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 03/23/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 03/23/2012 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 52- 001 -0090. You may obta of the rule uestions to OUNC by calling 503.232.8 or 1.800.332.2344.
Issued ' 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 �� FOR OFFICE USE ONLY
of Tigard �� ���� rLp\�" j
111 11
q 13125 SW HaII Blvd, Tigard, OR 17123 0- __ er Permit. , /
Phone: 503.718.2439 Fax: 503.598.196 Y �`9
�:
T I G A R U Inspection Line: 503.639.4175 'r r G� \ O Date Ready/By: El See Page 2 for
Internet: www.tigard-or.gov G s` Notified/Method: Supplemental Information
TYPE OF WO 1 \. PLAN REVIEW
❑ New constructi ® Addition/alterati 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.
lees to ground, or exceeds 14,000 ❑ Commercial -use agricultural
MI- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other. ❑ Fire pump. ❑ Inusilation of 75 KVA or
❑ Emergency system larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
100HP or more. occupancy.
Job no.: Job site address: (I 3 8 ID S w I R o tW,, O G �* ) ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: 1 (� O ft Z ❑ Health -care facilities. ❑ Supply voltage for more than
T ((r A I 7 ❑ Hazardous locations. 600 volts nominal.
Suitefbldg. /apt. no.: Project name: ❑ 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.
1,000 sq. ft- or less 168.54 4
Subdivision: C-1•4 (=- L E c 0 D Lot no.: Ea. add'1500 sq. R or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. R) 75.00 2
/
11 `` ,, (� �+ Limited energy, multi- family 75.00 2
C f;r'e E Ou T "C \ S T7 h1 Cr FP C ✓1-0O P' residential (with above sq. R.)
Services or feeders installation, alteration, and/or relocation
L'Z C- 2. 1 C A- L P E L TO 1.4. E W O N F 200 amps or less I 100.70 /0, 70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
\\ 401 amps to 600 amps 20034 2
Name: C u R T 1 5 11 € R R 601 amps to 1,000 amps 301.04 2
Address: X 1 3 t co S W (R o w V,( c o b L P Over 1,000 amps or volts 552.26 2
City/State/ZIT': /State/ZIP: Temporary services or feeders installation, alteration, and/or
Ty T 1 . - �- ( relocation
Phone: ( 5 311 (p 't; Z 13 Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, exc ge, according t ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branchsir cuit4 —new, alteration, or extension, per panel
Owner signature: 0 , vu..i Date: 0 3. 13 • I Z - A Fee for branch circuits with
❑ APPLICANT I ❑ 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 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pinup or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy
Business name: 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 (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
90.00/ hr
specifically listed (54 hr min)
CCB Lic.: Electrical Lic.: I Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: a Subtotal: f� 7()
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): /,Z . 14
TOTAL PERMIT FEE. / fol. t.
Authorized signature: This permit application expires if a permit is no obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PennitApp.doc 07/01/10 440- 4615T(t troSICOM/WEB
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Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing per mits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this horn eowner statement is true and accurate.
_./e 0 . \A
Print Name of Permit Applicant
c.c.4iLTtS 0. tE o3- Zg. 2o1 'L-
Signature of Permit Applicant Date
Permit #: � �Ol)- X)I &2(o #1:45
Address: 1/38 W. - 1-refi /cikkret . = .:,, , ice,
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Issued by: 7 Date: _ 3 )�/ /� 1 "
This Copy for Permit Offices