Permit %
CITY OF TIGARD ELECTRICAL PERMIT
1 c COMMUNITY DEVELOPMENT Permit#: ELC2009 -00546
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/15/2009
Parcel: 1 S135DD00600
Jurisdiction: Tigard
Site address: 11831 SW PACIFIC HWY •
Subdivision: Lot: 0
Project: Young's Funeral Home
Project Description: Install new sub panel and (2) branch circuits for sign.
Owner: FEES
ALDERWOODS (OREGON) INC Quantity Description Date Amount
BY SERVICE CORP & SUBSIDIARIES, ATTN:
PROPERTY TAX -9TH FLOOR, PO BOX 130548 1 ea Services or Feeders - 200 10/15/2009 $100.70
amps or less
PHONE: 2 crt Branch Circuits w /Purchase 10/15/2009 $14.84
Service or Feeder
1 ea 12% State Surcharge - 10/15/2009 $13.86
Contractor: Electrical
ELECTRICAL INNOVATIONS
22300 S LEWELLEN RD
BEAVERCREEK, OR 97004 -8733
PHONE: 503 - 358 -6989
FAX: 503- 632 -6564
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $129.40
Required Items and Reports (Conditions)
•
This per •' • - • •'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be • • e in accordance wit = •proved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
• = s. ATTENTION: Oregon la r• • •fires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
• 52- 001 -0010 through OAR 952 -00 1100. m oo stain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
l ���
Issued By: Permittee Signature: i
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: O
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.
i. Ele Permit Application hoR 01.l ICI: usr: ON 1.
1N City of Tigard Received / Permit No.: �r //
q 13125 SW Hall Blvd Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
f I G n It D Inspection Line: 503.639.4175 Date Ready/By: &I 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 a 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 ", "I -3 ",
Job no.: Job site address: 1 a ill ..5(0 I cc.j -k, I Snob or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Autj f 5 f ) A i , / � ❑ Service or feeder 600 amps or more.
L FEE SCHEDULE
Cross street/directions to job site: f�L!/(/ i[lfi - r
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 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
Ak .) ..1.4 I- Pc. Limited energy, multi -family 67.84 2
C/ G � GC vfrt. a ,e-vow, residential (with above sq. ft.)
1"6 k. / /+ Services or feeders installation, alteration, and/or relocatio
, c re- ii oo K. L� e J 1` VI c -f re Cwt. t' 1- 200 amps or less i 100.70 /OD?� 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 .
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I 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, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: • Date: Branch circuits - new, alteration, or extension, per panel _
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, z
each branch circuit 7.42 / 4 8y 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 56.18 2
first branch circuit
Address: Each add'I branch circuit 7.42 _ 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited -
Business name: I/sC-Gt, ( 1;4, Vl.c C .q+t 0.45 I4, energy panel, alteration, or
Address: Z�3✓0 < LCiieie4 extension. Describe: Page 2 2
City/State /ZIP Lie,f7G 02 S 7p p -- Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: 193 35 ' S I Fax: j ') 6$ 6'1 Investigation per hour (I hr min) 66.25
CCB Lic.6 It/2 I Electrical Li-6'9 Suprv. Lic.342,1 5 Industrial plant per hour 78.18 _
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, requi = Subtotal: / /55. f
Print n. e • (�� � /f Date: Plan review (25% of permit fee): e '
aa
/ State surcharge (12% of permit fee): /3.
Authorized signature: TOTAL PERMIT FEE: /A61 , b
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 'Permits\ELC- PerrnitApp.doc 10/01/09 4404615T(11/05/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 $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
y
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84 •
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
❑ Other
Total number of commercial systems:
*No . licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 10/01/09