Permit u CITY OF TIGARD ELECTRICAL PERMIT
° COMMUNITY DEVELOPMENT Permit #: ELC2009 -00208
T t G AR o 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/11/2009
Parcel: 2S102CD02802
Jurisdiction: Tigard
Site address: 9865 SW OMARA ST
Subdivision: Lot: 0
Project: McDonald
Project Description: (1) branch circuit for tankless water heater.
Owner: FEES
MCDONALD, TERRY UDIANE L Quantity Description Date Amount
9865 SW OMARA
1 crt Branch Circuits 05/11/2009 $46.85
TIGARD, OR 97223
Feeder
Service or
PHONE: 503 - 639 -3573
Feeder
1 ea 12% State Surcharge - 05/11/2009 $5.62
Contractor: Electrical
OWNER
TIGARD, OR
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $52.47
Required Items and Reports (Conditions)
This permit i - . - bject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do = in accordance MI . pproved • lans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the
180 •ays. ATTENTION: Oregon"' re• r= you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
9 i -001 -0010 thr• ugh OAR 952 -' • r 100. • u ay obtain a copy of e rules or direct questions to OUNC by calling 503.4 6:4 r ,6 1:0..332.23411 •
� / - J
ssued By: / � �/� t� Permittee Signature: v �� JS
OWNER INSTALLATION ONLY
The installation is being made on props lo n w ich/i/►/ nndeedfofo lease or re
OWNER'S SIGNATURE: ` ` ' ' Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N 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.
ik leetrical Permit Application FOR OFFICE USE ONLY
III City of Tigard Received Q do
`, DateB
q
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/B Permit No.:��e9— gap : Other Permit:
I I G A It D Inspection Line: 503.639.4175 Date Ready/By: luris: El See Page 2 for
Internet. www.tigard - or.gov Notified/Method: Supplemental 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 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 ", "1 -2 ", "I -3 ",
Job no.: Job site address: 9 �� O N Q 100 or or more. occupancy.
❑
❑ Six or more residential units. Recreational vehicle parks.
City/State /ZIP: %a/ �� \ O n_ cti 22 3 ❑ Health -care facilities. ❑ Supply voltage for more than
�"� ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. Project /� r b ❑ Service or feeder 600 amps or more.
no.: Project name: Y �p y \C�6 (� t'�L
FEE SCHEDULE
Cross street/directions to job site:
J 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. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
( (� f Limited energy, multi - family 75.00 2
' -1T5- �( �V� {° i S residential (with above sq. ft.)
C
U ` w r - X ^ l 1 1 rk-1. Services or feeders installation, alteration, and /or relocation
� r� ) Ct fa 200 amps or less 80.30 2
' ❑ PROPERTY. OWNER ❑ TENANT . 201 amps to 400 amps 106.85 2
Name: ` le L m e D
� a0 6 N A LO 401 amps to 600 amps 160.60 2
v l V `(� l� Over 1,000 amps amps 240.60 2
Address: (do Over 1,000 0 amps mps or volts 454.65 2
City/State /ZIP: ( /n P (2 0 t ' c: t - 2 2 S Temporary services or feeders installation, alteration, and /or
`�� ` ` relocation
Phone: O 6.2g ;s7 S Fax: ( ) 200 amps or less 66.85 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, t, r ange, cording to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature A. Date: S 4)1 �+(] A. Fee for branch circuits with
- . ❑ A PLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
without service or feeder fee, /�,
Contact name: first branch circuit / 46.85 V ,,d'
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
CONTRACTOR . Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: energy panel, alteration, or
Address: fil 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 (I hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
Suprv. Electrician signature, required:
Subbtt ELECTRICAL PERMIT FEES ,�
otal: _�/,/ .6
Plan review (25 % of permit fee):
Print name: Date: 5, State surcharge (12% of permit fee): 2
Authorized signature: TOTAL PERMIT FEE: 5a 6 .f 7
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• • Number of inspections allowed per permit.
I:\Building\Permits\ELC- PermitApp.doc 05/23/06 440- 46t5T(II/05 /COM/WEB
Electrical Permit Application - City of Tigard ❑ Other
Page 2 - Supplemental Information Total number of commercial systems: _
LIMITED ENERGY PERMIT FEES: *No licenses are required. Licenses are requir
for all other installations
RESIDENTIAL WORK ONLY:. - .
Fee for all residential systems $75.00
combined
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
❑ Boiler Controls
❑ 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
1: 1Building \Permits\ELC- PermitApp.doc 03/23/06
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