Permit •
CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELC2012 -00633
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TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/06/2012
Parcel: 1 S133DC09600
Jurisdiction: Tigard
Site address: 13175 SW SHORE DR
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Project: Christenson Subdivision: WINTER LAKE Lot: 24
Project Description: (2) branch circuits for attic fan and sump pump.
Contractor: WEBER ELECTRIC INC Owner: CHRISTENSON, CHRIS & EUNICE M
7007 SW ROBBINS RD 13175 SW SHORE DR
TUALTIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 819 -7380 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 11/06/2012 $63.60
Specifics: Service or Feeder
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1 ea 12% State Surcharge - 11/06/2012 $7.63 •
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 - • ano- h approved plans. This permit will expire if work is not started within : • - - • is.kuance, or if work is suspended for more the 180
days. AT NTION: Oregon -w r- • ' es you to follow the rules adopted by the Orego tility Center. Those rules are set forth in OAR
952-001-4010 thro gh OAR 952 -0.• -0090. • ay obtain a copy of the rules or direct questions to • NC by calling •' . 987 or 1.800.3 2.2344.
Issue By: Permittee Sig : ure: '- • ,
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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' / r ��� J 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 FOR OFFICE USE ONLY
City of Tigard Received // 4s� A_� &
i Permit No.:
IN
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
0 Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: HI See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction $ 4ddition/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.
�j less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
J"�- 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: 31 75- 5 1 or more. occupancy.
W Sh O p r ❑ Six ix or or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ❑ Health-care facilities. ❑ Supply voltage for more than
- 7 - ; 0.r 0 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: 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 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
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' Limited energy, multi- family 75.00 2
2 ck T 5 ' c,C ,L N residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
S v W /D rP L/ i,' u f 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:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
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: B. Fee for branch circuits without
service or feeder fee, first i 56.18 5Ct7 2
Contact name: branch circuit
Each add'1 branch circuit / 7.42 7, ( 2.2
Address: Miscellaneous (service or feeder not included) _
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder _
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: c z,e r 1 t iz C �n panel, alteration, or extension. Page 2 2
T" C Each additional inspection over allowable in any of the above
Address: 7 0 Q 7 SU 2 , (,,i, 1 - S R Additional inspection (I hr min) 66.25/ hr
City /State /ZIP: �+ Investigation (1 hr min) 66.25/ hr
�� 4t n , �� / ( ' Industrial plant (1 hr min) 78.18/ hr
Phone: (5 0)3 $1 / - 7 3 yo Fax: ( ) pi Inspections for which no fee is 90 00/ hr
specifically listed ('/5 hr min)
CCB Lic.: ,4 4 O v 7 Electrical Lic.31 _ 142 Lic.: 4 0 'L g S ELECTRICAL PERMIT FEES /
Subtotal: 3 • !�,
Suprv. Electrician signature, required: ' 76 Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): 7h 3
� _ J 2 TOTAL PERMIT FEE: ! 9, 3
Authorized signature: This permit application expires if a permit is not obtai within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\ Building \Pernits \ELC- PcnnitApp.doc 07/01/10 440.4615T(11/05/COM/WEB