Permit CITY OF TIGARD ELECTRICAL PERMIT
8 COMMUNITY DEVELOPMENT Permit #: ELC2012 00208
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/10/2012
Parcel: 2S110AD90030
Jurisdiction: Tigard
Site address: 14890 SW 109TH AVE
Project: MET LIFE HOME LOANS Subdivision: CANTERBURY WOODS CONDO Lot: 30
Project Description: Reconnect only.
Contractor: Owner: MET LIFE HOME LOANS
4000 HORIZON WAY
IRVING, TX 75063
PHONE: PHONE: 214 - 441 -4000
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 04/10/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 04/10/2012 $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 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 0 2- 001 -0090. You mmyyWeirr2'CBpy 0 the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 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 data.
This permit card shall be kept Ina 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
City of Tigard �� Y e^� DPlaan te /B ��. Permit No.: `O _ a
1 111
13125 SW Hall Blvd., Tigard, OR 9 1 Review
t
1 Other Permit:
D • Phone: 503.718.2439 Fax: 503.598.1960 c� y Date/By:
T I GAR D Inspection Line: 503.639.4175 i' '' '.i r ,,A Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov �i0� Notified/Method: - /„ Supplemental Information
TYPE OF WORK‘ �1yG `a PLAN REVIEW
❑ New construction
❑ Addition /alteratio' li acement 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
0 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A "E ", "l - ",' l -
Job no.: Job site address: I G'i) old / 0 100HP or more. occupancy.
❑
❑ Six or more residential units. Recreational vehicle parks.
City /Statc/ZIP: t ❑ Health -care facilities. ❑ Supply voltage for more than
� ❑ 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 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'l 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.)
• Limited energy, multi - family 75.00 2 • �i L G ins S � K j y SP V /G r residential (with above sq. ft.)
Cam' ' ( / Services or feeders installation, alteration, and/or relocation
4 - t) Be lit J( k1. Lte d h. 200 amps or less 100.70 2
c' PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
• Name: Mg / )4v to
amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: NDo p d V 1 7K wA . L t C 24:45 Over 1,000 amps or volts 552.26 2
Ti �� �� /' iv Temporary services or feeders installation, alteration, and/or
Le v 1 1,1, 1,1, relocation
Phone: (Zly ) 441_ Lib b 0 Fax: (ZIA) M41, By 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, le se, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits new, alteration, or extension, per panel
Owner signature: Date: 413 2br2__ A. Fee for branch circuits with
❑ APPLICANT [1l CONTACT PERSO above service or feeder fee 7.42 2
each branch circuit
Business name: 5'4.d,y f vb9cyil B. Fee for branch circuits without
/1 a w , service or feeder fee, first
Contact name: C u I branch circuit 56.18 2
� . e Each add'I branch circuit 7.42 2
Address: 1 D g !�44~ if Miscellaneous (service or feeder not included)
City /State /ZIP: VR" La LL 1J" C✓ �J a.. L & 1g L ti Each manufactured or dwelling, service and/or feeder modular 67.84 2
r feeder
Phone: (w 4\A 6„.. 44 4 1 Fax: : ( ) Reconnect only I 67.84 4 - 7• vi 2
C Y , e ?Ili h�ti,,t Pump or irrigation circle 67.84 2
E
Sign or outline lighting 67.84 2
CONT T � b� ►vim - t , OR 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
Investigation (1 hr min) 66.25/ hr
City /State /ZIP: Industrial plant (1 hr min) 78.18 / hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed CA hr min) 90.00 / hr
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee):
TOTAL PERMIT FEE: 7c 0
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
1:\ Building \ Permits \ELC•PermitApp.doc 07/01 /10 440- 4615T( 1 I /05 /COM/WEB