Permit •
CITY OF TIGARD ELECTRICAL PERMIT
2 • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00652
T EGARO 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/14/2012
Parcel: 2S111CB01749
Jurisdiction: Tigard
Site address: 10104 SW LADY MARION DR
•
Project: Brown Subdivision: HOOD VIEW Lot: 2
Project Description: (1) branch circuit for water restoration project and re -wire two can lights
Contractor: NEEL ELECTRIC INC Owner: BROWN, RICHARD K & CAROLYN M
2931 REDFIR CT., NE 12670 SW 68TH AVE #300 •
SALEM, OR 97034 TIGARD, OR 97223
PHONE: 503 - 701 -6257 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 11/14/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/14/2012 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2
K
Issued By: / 131 Permittee Signature: DM PP(I C W U
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 n
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 Ft)1z lc :l•: 1, s 1 : 1 : RECEIVE___ Clty of Tlgard .., (ta
Permit No.:E'(,G Am a .- to 4,6
13125 SW Hall Blvd., Tigard, OR 97223 NOV 1 4 2012 plan Review Other Permit:
C • Phone: 503.718.2439 Fax: 503.598.1960 Date/B :
TI G A I. D Inspection Line: 503.639.4175 /� � • Date Ready/By: ruris: RI See Page 2 for
Internet: www.tigard- or.gov O RD Notified/Method: ?} Supplemental Information
TYPE OF WOI ((�� T { Y V ILD r`G DIVISION PLAN REVIEW
1:1 New construction Addition/alteration/replacement Please check all that apply (submit 2 leis 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
f it ) 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 INFORMA ON AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1-2", "1 -3"
Job no.: Job site addr j(-1 c 's ,may ' IOOHPormore. occupancy.
•1 1 �' t ) W �� `a►1�" 0 Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: T1�� 0 P • ell Zl' W — ❑ 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: 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'I 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.)
Limited energy, multi - family
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W Ai� rt Ob" 4i011" i il` et. R e ' Ijt�1 V f 4 ' (4 kb residential (with above sq. ft.) 75.00 2
II Y Services or feeders installation, alteration, and/or relocation _
11;4+S • 200 amps or less 100.70 2
.00 PROPERTY OWNER I ❑ 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
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
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 I ❑ CONTACT PERSON above service or feeder fee, 7.42 2
J
each branch circuit
Business name: ; `je �� � 4 I e B. 1St(• B. Fee for branch circuits without I
service or feeder fee, first
Contact name: S irk v E E, 1 .. N branch circuit 56. I 2
Each add'l branch circuit 7.42 2
Address: 12410 Sw 6 gm Aw. silt 76d I Tj 't 0 , C It Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (93 ) 61 - Sdf v 3 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: , (1 panel, alteration, or extension. Page 2 2
Qi � ��q , q Each additional inspection over allowable in any of the above
Address: 2_9 3 / oz.. C /l / E Additional inspection (I hr min) 66.25/ hr
City/State/ZIP: �, yt /J� 7d 341 Investigation (I hr min) 66.25/ hr
C Industrial plant (1 hr min) 78.18/ hr
Phone: ($02) 0 / - , S Fax: ( ) //)// 1(3 Inspections for which no fee is
2 7 k - s • S ) 1 C 7 y \ -7s s listed (% hr min) E/ hr
CCB L � � kc cal Lic.0 Suprv. Lic.: d A ELECTRICAL PERMIT FEES •
Suprv. Electrician signature, required: Subtotal: +5 ,
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee):
//� `_ TOTAL PERMIT FEE: b a.9 a- `e
Authorized signature: 1(44 d k, y i This permit application expires if a permit is not obtained within 180
14 days after it has been accepted as complete.
Print name: ; Ic, 1 I L e I Date: II- 11. i1.. • Number of inspections allowed per permit.
I:\ Buildin g\Permits\ELC.PennitApp.doc 07/01/t0 440- 4615T(11ro5 /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
❑ 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
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