Permit I CITY OF TIGARD ELECTRICAL PERMIT
`• a COMMUNITY DEVELOPMENT Permit #: ELC2009 -00541
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/13/2009
TIGARD. Parcel: 1 S 134CB00207
Jurisdiction: Tigard
Site address: 12535 SW SUMMER CREST DR
Subdivision: Lot: 0
Project: Williams
Project Description: Installation of feeder and (1) branch circuit for accessory building.
Owner: FEES
WILLIAMS, PAUL M & LINDA L Quantity Description Date Amount
12535 SW SUMMER CREST DR
TIGARD, OR 97223 1 ea Services or Feeders - 200 10/13/2009 $100.70
amps or less
PHONE: 5 crt Branch Circuits w /Purchase 10/13/2009 $37.10
Service or Feeder
1 ea 12% State Surcharge - 10/13/2009 $16.54
Contractor: Electrical
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $154.34
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 ' • . • • - - - 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. • TTENTION: Oreg. law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 601 -0010 through OAR 95' -' • -• 00. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332,2344.
00.
•sued By: Permittee Signature: ���...
OWNER INSTALLATION ONLY
The installation is being made on property I o , . hich is not intended for sale, lease or rent. / /
OWNER'S SIGNATURE L - _ • � wW Date: (D ! /O f
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
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.
r1 '
Electrical Permit Application FOR (11:1:IC1•: I;s1.1 ONLY
ed
City of Tigard Received
: l0 Are Wal Permit No.: E46a00,:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
G . Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: lads: See Page 2 for
Internet: www.tigard- or.gov Notified/Method: / Supplemental Info
TYPE OF WORK PLAN REVIEW
® New construction ❑ 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 0 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: 12535 SW Summer Crest Dr IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/ State/ZIP: Tigard, OR 97223 ❑ 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: SW Summer Crest DR & SW North Dakota Description I Qtr. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
one block south of intersection Includes attached garage.
Subdivision: Lot no.:
1,000 sq. ft. or less 168.54 4
Tax map /parcel no.:
DESCRIPTION OF WORK Ea. add'I 500 sq. ft. or portion 33.92 1
Install electric service to accessory building
Limited energy, residential 67.84 2
(with above sq. ft.)
® PROPERTY OWNER I ❑ TENANT
Limited energy, multi - family 67.84 2
Name: Paul Williams residential (with above sq. ft.)
Address: 12535 SW Summer Crest Dr Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100.70 100.70 2
City/ State/ZIP: Tigard, OR 97223
201 amps to 400 amps 133.56 2
Phone: (503)590 -7034 Fax:( )
Owner installation: This installation is being made on property that I own which is not
intended for sale, leas --- .t, or exchange according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 200.34 2
Owner signature: .. A , _ , i , ' szszr.,--- --- Date: /a,/ 3l C9�'
❑ • PPLICANT I ❑ CONTACT PERSON 601 amps to 1,000 amps 301.04 2
Business name:
Contact name: Over 1,000 amps or volts 552.26 2
Address: Temporary services or feeders installation, alteration, and/or
relocation
City/State/Z I P:
200 amps or less 59.36 1
Phone:( ) Fax::( )
E -mail: 201 amps to 400 amps 125.08 2
CONTRACTOR
Business name: D C,t) !V 2 401 amps to 599 amps 168.54 2
Address: -
Branch circuits — new, alteration, or extension, per panel
City/State/ZIP: A. Fee for branch circuits with
above service or feeder fee, 5 7 42 37.10 2
Phone: ( ) Fax: ( ) each branch circuit
B. Fee for branch circuits
CCB Lic.: Electrical Lic.: Suprv. Lic.: without service or feeder fee, 56.18 2
first branch circuit
Suprv. Electrician signature, required:
Each add'I branch circuit 7.42 2
Print name: Date:
Miscellaneous (service or feeder not included)
Authorized signature:
Each manufactured or modular 67.84 2
Print name: Date: dwelling, service and/or feeder
I:\ Building \Pentuts\ELC- PennitApp.doc 10/01/09 440-4615T(I IN5 /COM/WEB
o — i 4 L /sy • 3Y
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Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
Signal circuit(s) or limited -
energy panel, alteration, or
extension. Describe: Page 2 2
Each additional inspection over allowable in any of the above
Per inspection 66.25
Investigation per hour (I hr min) 66.25
Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Subtotal: 137.80
Plan review (25% of permit fee): -3443 or
State surcharge (12% of permit fee): 16.54 . 5
TOTAL PERMIT FEE: .188-.94 1
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.
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I: Building \Permits\ELC- PennitApp.doc 10/01/09
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