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Permit • n C ITY OF TIGARD ELECTRICAL PERMIT II D COMMUNITY DEVELOPMENT Permit #: ELC2012 -00653 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 • Date Issued: 11/15/2012 Parcel: 2S112BA05000 Jurisdiction: Tigard • Site address: 14365 SW 80TH PL Project: Skorpen Subdivision: WAVERLY MEADOWS Lot: 6 • Project Description: 125 amp panel change Contractor: HARBOR NORTHWEST ELECTRIC LLC Owner: SKORPEN, NEAL J & . 1404 NE 17TH AVE MORAVEC, MARCIE L BATTLE GROUND, WA 98604 14365 SW 80TH PL TIGARD, OR 97224 PHONE: 503 - 358 -8723 PHONE: • FAX: FEES • Quantity Description Date Amount 1 ea Services or Feeders - 200 11/15/2012 $100.70 Specifics: , ' amps or less 1 ea . 12 % State Surcharge - . 11/15/2012 $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 •ther applicable law. All work will be done i ordanc= 'th approved plans. This permit will expire if work is not started within 180 days of issu: ce, or if wo is suspended for more the 180 days. ENTION: Oregon law • •' es you to follow the rules adopted by the Oregon Utility Notification enter. ' h•.e rules are set forth" in OAR 952 -00 0010 through OAR 95 0 •.1- 0090. ay obtain a copy of e rules or direct questions to OUNC by calling 503.2 2. 987 0 .:'0. 32.2344. vie Issued Permittee Signature: .&i '` 16 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: ' O TRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' 4:: Date: i ` ^ 17 ,_ I —Z__ . LICENSE NO. Cali 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 F•oll; owlet: Hsi.: oNl.Y City of Tigard Received Date/B : �I ® permit No.: `.1 A /•65 q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 0 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: I I C. n it p Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction [1E1-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 ❑ 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 C14-1 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: ) 4- , , S ) . 80 % ,7 I or more. occupancy. ❑ Six x or or r more residential units. ❑ Recreational vehicle parks. City/State /ZIP: - r, Co flo / r . w` 224 ❑ Health -care facilities. ❑ Supply voltage for more than J ❑ 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 Qt I Fee. I Total I • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4 Ea. add'l 500 sq. R. or portion 33.92 I Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi-family 75.00 2 12. A- , residential (with above sq. ft.) P e —' Se rvices or feeders installation, alteration, and/or relocation _ 200 amps or less 1 100.70 100 .70 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 601 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 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: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'I branch circuit 7.42 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: t 4. ,,, 6O Y L\00 wad e.e.t 1 r ; c. LLC.r panel, alteration, or extension. Page 2 2 ' Each additional inspection over allowable in any of the above Address: tl) 4- NNE ' p V / Additional inspection (I hr min) 66.25/ hr City/State /ZIP: L 7!: fT 6„ \ Investigation (1 hr min) 66.25/ hr tL Ol ) W }� . 9 ( O� 4 ' Industrial plant (1 hr min) 78.18/ hr Phone: 605) 35$ _ ^�23 F ( ) Ar Inspections for which no fee is s listed % hr min 90.00/ hr /� !e/ J 4 5751 specifically ( ) CCB Lic. : 91 (� G � \S E ectrical Lic.: G � • Suprv. Lic.: ELECTRICAL PERMIT FEES ; r , ∎ _ _ Subtotal: 100. 70 Suprv. Electrician signature, required: o \10 Plan review (25% of permit fee): Print name: // • Date: State surcharge (12% of permit fee): /,Z - oQ' G.V• 1 ur n- ��' �.�-� • TOTAL PERMIT FEE: 0 A, 7 $ Authorized signature: This permit application expires if a permit is not obtained within ISO Print name: Date: • days after it has been accepted as complete. Number of inspections allowed per permit. I :\ Building \Permits\ELC•PermiWpp.doc 07/01/10 440- 461ST(I1/05 /COM/WEB Electrical Permit Application - City of Tigard •Page2•- 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 1:\ Building \Prnnits\ELC- PermitApp.doc 07/01/10