Permit ,� CITY OF TIGARD ELECTRICAL PERMIT
• o.. COMMUNITY DEVELOPMENT Permit #: ELC2009 -00200
T I G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.639 4171 Date Issued: 05/06/2009
Parcel: 2S104AD02900
Jurisdiction: Tigard
Site address: 12955 SW WALNUT ST
Subdivision: Lot: 0
Project: Gardiner
Project Description: Rewire entire house Service panel and 40 branch circuits.
Owner: FEES
GARDINER, GAIL E Quantity Description Date Amount
8015 SW CANYON LN 1 ea Services or Feeders - 200 05/06/2009 $80.30
PORTLAND, OR 97225 amps or less
PHONE: 40 crt Branch Circuits w /Purchase 05/06/2009 $266.00
Service or Feeder
Contractor: 1 ea 12% State Surcharge - 05/06/2009 $41.56
OWNER Electrical
PHONE.
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $387.86
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 th 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. ATTE ON Oreg law - • uires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952- 001 -0010 rough OAR 952 -0 .1 •100. Yo 1 ay obtain a copy of the rules or direct questions to OUNC by calling 5032. • • r 1890.332 4.
Issued y: ) -A .1. % i P ermittee Signature: " 1L` .' --` -7
OWNER INSTALLATION ONLY
i
The installation is being made on prope •wwn • chta -not in •ed for sale, lease or rent. /'
OWNER'S SIGNATUR 'ear /Y
` . 7 • Date: V
111111V MI/
fir CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N 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.
' • Electrical Permit Application FO OFFICE USE ONL ' .
City of Tigard Received
5 �� Permit No ft2 f -.�',,
N C . 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit
C Phone' 503 639 4171 Fax 503 598.1960 Date/By
T I G A RD Inspection Line 503 639 4175 Date Ready /By Juns SI See Page 2 for
Internet: www tigard -or gov Notified/Method Supplemental Information
TYPE OF PLAN REVIEW
❑ New construction ❑ Additio ` Iteration/ lacement Please check all that apply (submit 2 sets of plans whtems 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
(❑ 1-- d 2- family dwelling El Commercial /industrial ❑ Accessory building amps for all other installations buildings
El Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system 1 larger separately derived system
El Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
Job no.: Job site address: I OOHP or more occupancy
12 _6\s - s -- Sup) AL ,L}'� ❑ Six or more residential units ❑ Recreational vehicle parks
City /State /ZIP: �--mi�ll � /y�1 ❑ Health -care facilities ❑ Supply voltage for more than
���� O�itCl7CJN "l L 2-2� ❑Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: 12 s weLpt ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: (2_c } - V t�C-0 ' [ GA,Lo Q" Description I Qty. I Fee. 1 Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: • Lot no.: 1,000 sq ft. or less 145.15 4
Tax map /parcel no.: Ea add'I 500 sq ft or portion 33 40 1
Limited energy, residential 75 00 2
_ DESCRIPTION OF WORK (with above sq. ft )
�� Limited energy, multi- family 75.00 2
W, /I 1 ,. 171 d4� �5,� residential (with above sq 11 )
`' i t `' Services or feeders installation, alteration, and/or relocation
200 amps or less / 80 30 5"p, 36 2
PROPERTY OWNER ❑. TENANT 201 amps to 400 amps 106 85 2
Name: d+ 1 L_ ( 1 AL 401 amps to 600 amps 160 60 2
4 601 amps to 1,000 amps 240.60 2
Addrey Y4.1 ia4 / �- Over 1,000 amps or volts 454 65 2
City/State/ZIP: 716 Da_ 0 1 3 Temporary services or feeders Installation, alteration, and/or
"( relocation
Phone: ( ) ' Fax: ( ) 200 amps or less 66 85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100 30 2
intended for sale , exc r , ge, according to • RS 447, 449, 670, and 701. 401 amps to 599 amps 133 75 2
g t� t.� ✓L Branch circuits - new, alteration, or extension, per panel
Owner signa e: Date: S / O _�
A. Fee for branch circuits with ■ (p( Q a0
yr
❑ APPLIC • ❑ CONTACT PERSO above service or feeder fee, /O 6 65 2
each branch circuit ll
Business name: B Fee for branch circuits
Contact name: without service or feeder fee, 46 85 2
first branch circuit
Address: Each add] branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53 40 2
CONTRACTOR Sign or outline lighting 53.40 - • 2
} Signal circuit(s) or limited-
Business name:
O W p 3 _ r. energy panel, alteration, or
Address: extension Describe Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62 50
Phone: ( ) Fax: ( )
Investigation per hour (1 hr min) 62 50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industnal plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal 3 46 • 49
Print name: Date: Plan review (25% of permit fee) Q—.
State surcharge (12% of permit fee). 4%7 • .57p
Authorized signature: TOTAL PERMIT FEE. 38 7, ` 6 7
Print name: Date: 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
i \ Building \Permits\ELC- PermitApp doe 05/23/06 440-4615T(11 /05 /COMJWEB
Electrical Permit Application - City of Tigard •
Page 2 - Supplemental Information
LIMITED ENERGY PtRMIT 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
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls P -
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Buildmg'Permns\ELC- PermitApp doc 03/23/06