Permit CITY OF TIGARD ELECTRICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: ELC2012 -00175
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/28/2012
Parcel: 1 S125DC06200
Jurisdiction: Tigard
Site address: 9700 SW 74TH AVE
Project: AP Pacific Subdivision: ASH CREEK GATES Lot: 4
Project Description: Electrical reconnect only.
Contractor: NEC ELECTRIC Owner: AP PACIFIC
1508 NE 194TH ST 800 NE TENNY RD STE 110 -423
RIDGEFIELD, WA 98642 VANCOUVER, WA 98085
PHONE: 360 - 798 -2819 PHONE: 360 - 967 -4303
FAX: 360 - 807 -0752
FEES
Quantity Description Date Amount
1 ea Reconnect Only 03/28/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 03/28/2012 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 ', • k is suspended ' more the 180
days. ATTENTIO.. •re! • law - • uires ou to follow the rules adopted by the Oregon Utility Notification Cente ose rules are =t forth in OAR
952- 001 -0010 • ough OAR 95 1 -0 '. •may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19•, • .800.332
lif Issued By ` 2 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 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 roll or rlcl: usl ONLY Received City of Tigard RECEIVED Date/By: Ged S •
J 4 Permit No.: E'�jD�a -e /1-75
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review C n �, n ��
Phone: 503.718.2439 Fax: 503.598.1960M 2 8 2012 Date/By: Other Permit: 1 G i
T I C. A It u Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF v 1Utt.DING DIVISION PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit 1 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 ", "1 -3 ",
Job no.: Job site address: q - 7 n �' /�Q loop or more. occupancy. / 7 O h l �N/ �� Y [ ❑Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: I Q� n O� ❑ Hazardcure lo facilities.
❑ Supply voltage for more than
/v (w`c OP ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qn. 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 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
r L energy, multi- family 75.00 2
-e told .,. {_ a e n , / f az residential (with above sq. ft.)
h� v 1� Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: relocation
Phone: ( ) • 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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or ex tension, per panel
Owner signature: Date: 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'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State /ZIP: dwelling, service and/or feeder
Fax: ( ) R only , J 67.84 4, "2 , _glf 2
Phone: ( ) /
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limitcd - energy
Business name: A i E C r e l `o panel, alteration, or extension. _ _ Page 2 2
Each additional inspection over allowable in any of the above
Address: la) g ,i `9l' S cl Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: 12 , eri . e.. . c _ c i �/ / �� ��� Investigation (1 hr min) 66.25/ hr
ry / �7 Industrial plant (1 hr min) 78.18/ hr
Phone: (<11 ) $ 2..1 19 Fax: (So) o 7 ` . Inspections, for which no fee is 90.00 / hr
specifically list (%: hr min)
CCB Lic.: lc? 3 0 Electrical Lic.: $ °/ L I S k Suprv. Lic.: " J .7S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 7 g- 9
Plan review (25% of permit fee): ,
Print name: Date- 0 3 , 2 s . IL State surcharge (12% of permit fee): �{ #I
Authorized signature: att....,14;L, TOTAL PERMIT FEE: '7� �1
This permit application expires if a permit is not obtained within 180
Print name: V � 3 . � 1_ , days after it has been accepted as complete.
Q / `+ .� ��lG Date: t7 N um b er o inspections allowed per permit.
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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:
0 Audio and Stereo Systems*
Burglar Alarm
LI Garage Door Opener*
Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
0 Audio and Stereo Systems
CI Boiler Controls
LI Clock Systems
LI Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
E Instrumentation
LI Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
LI Nurse Calls
El Outdoor Landscape Lighting*
LI - . •
Protective Signaling
LI Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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