Permit CITY OF TIGARD ELECTRICAL PERMIT
: COMMUNITY DEVELOPMENT Permit# ELC2012 -00543
Date Issued 09/18/2012
T I G ARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S101 DCO3502
Jurisdiction Tigard
Site address 7424 SW FIR ST
Project Varhan Subdivision ROLLING HILLS NO 2 Lot 44
Project Description (1) 200 amp or less panel upgrade
Contractor GRESHAM ELECTRIC Owner VARHAN, ANDREW & VALERIE
4664 SE ANTELOPE HILLS DR 7424 SW FIR ST
GRESHAM, OR 97080 TIGARD, OR 97223
PHONE 503 - 810 -8140 PHONE 503 - 270 -1864
FAX 503 - 667 -9374
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 09/18/2012 $100 70
Specifics amps or less
1 ea 12% State Surcharge - 09/18/2012 $12 08
Type of Use SF Electrical
Class of Work ALT
Type of Const
Occupancy Grp
Total $112 78
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 1 -009 You may obtain a copy of 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 503 839 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 Applicatio p FOR OFFICE USE ONLY
° �
City of Tigard � E�ED Date/By ( /y ��- Permit No ��( O/a — �(J j
lIl • 13125 SW Hall Blvd , Tigard,OR 97223, Plan Review Phone 503 718 2439 Fax 503 598 196 1 8 01 Date/By Other Perm t ysi'o 4 _ DD 9 /
Inspection Line 503 639 4175 Date Ready/By Rins ® See Page 2 for
f I C, A R D C ITY OF Internet www tigard-or gov Notified/Method / Supplemental Information
TYPE ol3WAIIIING DIVISION PLAN REVIEW
❑ New construction AA ddition/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 stones
❑ 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
121 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
❑ Emergency system larger separately denved system
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
J� I00HP or more occupancy
Job no Job site address
�L 1 �� 5� Csr - C -4 ❑ Six or more residential units ❑ Recreational vehicle parks
l' a (�
City /State /ZIP I u ()r °F7 233 ❑ H ealth -care facilities Supply voltage for more than
t ��('a�` 1 ❑ Hazardous locations 600 volts nominal
Suite/bldg /apt no Project name Vc r-'n ail ❑ 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 l
Tax map /parcel no Limited energy, residential
DESCRIPTION OF WORK (with above sq R) 75 00 2
AAA Limited energy, multi - family 75 00 2
residential (with above sq ft )
1 P��P 1 ` O/� r �rn �P Services or feeders installation, alteration, and/or relocation
200 amps or less I 100 70 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133 56 2
I ` I t 401 amps to 600 amps 200 34 2
Name ` D .e C ∎ F V � \/ ✓1 601 amps to 1,000 amps 301 04 2
Address "1 Lk 2,-1 sw Rt.. 5kepe4. Over 1,000 amps or volts 552 26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP 1 . r 1 Ofd 1� 9 1 233 relocation
Phone ( ) 7 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 A Fee for branch circuits with
® APPLICANT ❑ CONTACT PERSON above service or feeder fee 7 42 2
,� each branch circuit
Business name (�t� D yl en E 1 ec �-ri c 14c B Fee for branch circuits without
\_ service or feeder fee, first 56 18 2
Contact name M 1 c\ `Cif t 1c-r-i1N branch circuit
Each add'I branch circuit 7 42 2
Address y 1 St An--eb pe E-t I lls t V P Miscellaneous (service or feeder not included)
Each manufactured or modular
Cit /State /ZIP
Y Gf aivl , GR or dwelling, service and/or feeder 67 84 2
Phone (6603 ) 1 0 - of 4 0 t Fax (rjb3) _ ? L,- . 7_ 9 -74 Reconnect only 67 84 2
7 � 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 1 panel, alteration, or extension Page 2 2
/ G (�Y1r1C�1/V1 r Ie[�-�' (�' j'tte Each additional inspection over allowable in any of the above
Address 4bt SP Aink' to p Wills Drive Additional inspection (I hr min) 66 25/ hr
v { i 0 Q 9 -X380 Drive
Investigation plant (I hr mm) 78 25/ hr
City/State /ZIP
G� wind 7 ✓ Industrial plant (I hr mm) 78 18/ hr
V o ne (�p3) � -�1 Lo
Fax (505 ) 66'l _ 93 4 yy Inspections for which no fee is 90 00/ hr
specifically listed (% hr mm)
B Lic 129 (053 E ectrical Lic 2 _100q Supry Lic .-b— ELECTRICAL PERMIT FEES
i 1 9 1
; I,,, / / `, �' Subtotal /o , 76
Supry Electrician signature eq lied �l ' E 4a e , // /3
Plan review (25% of permit fee)
Print name M' c ' v c t E i r» in Date 9 l , (21 1 , State surcharge (12% of permit fee) / 2 , Of
Authorized signature Y' TOTAL PERMIT FEE //a , ? E p
This permit application expires if a permit is not obtained within 180
Print name Date days after it has been accepted as complete
N umber o inspections allowed per permit
I \Building\Permits\ELC- PermitApp doc 07/01/10 440- 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
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
1
I=1 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
I \Building\Penmts\ELC- PermttApp doc 07/01/10