Permit CITY OF TIGARD ELECTRICAL PERMIT
0 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00339
Date Issued: 06/04/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 6/04/2 D05800
Jurisdiction: Tigard
Site address: 14736 SW 76TH AVE
Project: Safstrom Subdivision: PROSPECT MEADOWS Lot: 1
Project Description: Adding can lights in upstairs bath and wall heater in downstairs bath dedicated GFCI
Contractor: Owner. SAFSTROM, NICHOLAS
14760 SW 76TH AVE
TIGARD, OR 97224
PHONE: PHONE: 503 - 572 -4869
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 06/04/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/04/2012 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp: •
•
Total $79.54
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 52-001- 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.198 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 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 RF FOR OFFICE USE ONLY
Received &�t✓ r ,� -��
City of Tigard JUN 0 4 201
1, • Date/By: Permit No �Y/! �t�J j r
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
e Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
r Date/By:
TI G n R D Inspection Line: 503.639 CITY OF TIG A , u Date Ready/By: runs: ® See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISIO I Notified/Method: ACC V Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction A 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
IN 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 ", "1 -3 ",
r r I OOHP or more. occupancy.
Job no.: ' "Job site address: � /7? . SIrU �� //' 76 FtvL 0 Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: - ----- y ' Q f [/ ❑ Health -care facilities. ❑ Supply voltage for more than
/� / 4 1 ' 7 % 7 ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: / I Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: ? , b4 Description I Qsv. 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
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
4 /•61/VG C,9-A1 L! G/'73 (Al' a/'S7i41 //L 5 64 777/ 1 residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
lf/.9Lt . 7Z /N 15OZ2A/STr¢ //LS 9 D-ed,C4, 6ir 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
7t Name: ��`fO /�h 601 amps to 1,000 amps 301.04 2
Address: / 6 s� 77 w e Over 1,000 amps or volts 552.26 2
Temporary OA 9,2�� relocation services or feeders installation, alteration, and/or
City/State /ZIP:
�a r
Phone: ( 3) 7 Z_ [ / 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 extension, per panel
Owner signature: Date: lo- 6 y-r/2 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 i 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 City/State /ZIP: dwelling, service 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: Q p.,/ 4/6. 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
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 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
Suprv. Electrician signature, required: a Subtotal:
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee):
x Authorized signature: TOTAL PERMIT FEE: q s
T h i s perm app expires if a permit is not obtained within 1 0
Date: ( _ i / _ 2 41 2 * days after it has been accepted as complete.
f Print name: /�/ /�� f ��srno z..--4 Date: of inspections allowed per permit.
1:\Building\Permits\ELC- PermitApp.doc 07/0I/10 440- 4615T(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 .$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:
( 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
• 0 Clock Systems • •
❑ Data Telecommunication .Installation
•
❑ Fire Alarm Installation •
❑ HVAC
❑ Instrumentation
El . 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 alllother installations
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