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Permit
a CITY OF TIGARD ELECTRICAL PERMIT 0 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00278 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/11/2012 Parcel: 25111 BD00307 Jurisdiction: Tigard Site address: 9885 SW PEMBROOK ST Project: Pond Subdivision: PEMBROOK HEIGHTS Lot: 7 Project Description: Installation of gas fireplace insert into existing fireplace. Contractor: OWNER Owner: POND, DUANE P M & POND, SUSAN L VIROSTEK 9885 SW PEMBROOK ST TIGARD, OR 97224 PHONE: PHONE: 503 - 624 -5644 FAX: FEES Quantity Description Date Amount 1 crt Branch Circuits wo/Purchase 05/11/2012 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 05/11/2012 $6.74 Type of Use: Electrical Class of Work: Type of Const: Occupancy Grp: Total $62.92 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 a - pan.- with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspend- • •r more the 180 days. ATTE • I • N: Ore, •n law requires you to follow the rules adopted by the Oregon Utility Notification - • r. Those rules ar' forth in o • R 952- 001 -001' th {. ugh OAR • e r . • !O. You may obtain a copy of the rules or direct questions to OUNC by calling 503.: •r 1.800.332.2344. g Issued B : __ e -1__-.!_-.4 1 Permittee Signature _ .i'i. —/ NI r - OW ER INSTALLATION ONLY .. The installation is being made on property •wn hich is not intended for sal se or rent. OWNER'S SIGNATURE A \_ ,./ .I/. - . / � L a Date: �� //./ 2■ CONTRACTOR I STALLATION 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 1:0I% OFFICE USE ONLY City of Tigard RE CE i J Ebat. � � Permit No.: i 115 SW Hall Blvd., Tigard, OR 97223 Plan Review C Phone: 503.718.2439 Fax: 503.598.1960 MAY 1 1 2012 Date/E1 : Other Permit: f FIG IZ 1� Inspection Line: 503.639.4175 Date Ready/By: Jun,: EI See Page 2 for Internet: www.tigard - or.gov Cr if Of., tt Notified/Method: Supplemental Information ran TYPE OF W L j�, -� PLAN REVIEW Please check all that apply (submit sets of plans w /items checked below): CI New construction ❑ Addition/alteration/replacement t ❑ 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: �� t�w I F U V� �� I or more residential occupancy. ❑ P J �/� ❑ Six or or more residential units. Recreational vehicle parks. City/State /ZIP: T It " p /! yMl ©1 1 ,2,...„2.... ❑ Health -care facilities. ❑ Supply voltage for more than ) ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ej 1) ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qtr. 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.) / /J , ^ Limited energy, multi - family OA) 5 / Ai ` / to dd)" / 17 Z d ci 1 `C7C ,P /'��• 1 residential (with above sq. ft.) 75.00 2 V / Services or feeders installation, alteration, and/or relocation 5 ///kJ J _ (J) ! ' 200 amps or less 100.70 2 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 00C//(/,p lt/ 601 amps to 1,000 amps 301.04 2 Address: l V r"J �I ` ✓ ,„,,v < 5 Over 1,000 amps or volts 552.26 2 City/State /ZIP: j O,k a 2 �, � 4 Temporary services or feeders installation, alteration, and/or ` relocation Phone: (5 )3 ‘ 5 l / Fax: ( ) 200 amps or less 59.36 1 l 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on r roperty that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, l. nt, or exchan' * ccording t • RS 447, 449, 670, d 7 1. Branch circuits — new, alteration, or extension, per panel . Owner signature. I! ! 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 SV •J2' 2 Contact name: branch circuit Each add'I branch circuit 7.42 2 • Address: Miscellaneous (service or feeder not included) Each manufactured or modular City/State /ZIP: dwell ng, servicee and/or feeder 67.84 2 Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump 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 Address: OW e/€ Each additional inspection over allowable in any of the above Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (I hr min) 78.18 / hr Phone: ( ) Fax: ( ) Inspections for which no fee is specifically listed (A hr min) 90.00 / hr CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES rg Suprv. Electrician signature, required: Subtotal: 6 ,. Plan review (25%of permit fee): Print name: Date: State surcharge (12% of permit fee): G . 7 y TOTAL PERMIT FEE: a , cj 2 Authorized signature: This permit application expires if a permit is not obtaine within IS0 Print name: Date: days after it has been accepted as complete. Number of inspections allowed per permit. 1: 1Building \Permits\ELC- PermitApp.doc 07/01 /10 440.4615T(1I /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 $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* • ❑ Heating, Ventilation and Air Conditioning System* ■ ❑ Vacuum Systems* ❑ Other: F COMMERCIAL WORK ONLY: 1 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 ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:\ Building \Permits\ELC- PennitApp.dot 07/01/10