Permit 111 CITY OF TIGARD ELECTRICAL PERMIT
8 . COMMUNITY DEVELOPMEN Permit #: ELC2012 00686
Date Issued: 12/06/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S110AD01700
Jurisdiction: Tigard
Site address: 14620 SW 106TH AVE
Project: Caicedo Subdivision: LANG HILL Lot: 14
Project Description: (2) branch circuits for washer & dryer circuits to copper. 4 -wire Cap off AL in attic and access
Contractor: TDS ELECTRICAL CONTRS. Owner: CAICEDO, CARLA SUE
PO BOX 1521 14620 SW 106TH AVE
CLACKAMAS, OR 97015 TIGARD, OR 97224
PHONE: 503 - 710 -0866 PHONE:
FAX: 503 - 698 -4519
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 12/06/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/06/2012 $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 applicabb I• 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 sus? I.
• ore 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Ce ter. Those r a, fort in OAR
952- 001 -0010 through OA 9 2 -001- 090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 . •87 or 1,800.33 4.
�.i ._,
Issued By: Perm ittee Signature: 4 - � / //-
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 503.639.4175 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 ApplicationE ,EIVED FOR OFFICE USE ONLY
_�,A
City of Tigard Received
Date/By: t�(t l / 2- Permit I WI.) -,06
114 D
• 13125 SW Hall Blvd., Tigard, OR 97223 EC 06 2012 Plan Review
Phone: 503.718.2439 Fax: 503.598.196 Date/By: Other Permit:
Inspection Line: 503.639 A p Date Ready/By: luris: El See Page 2 for
TI GARD CITY OfTIGARD ��O
Internet: www.tigard -or.gov CITY Supplemental Information
TYPE OF wt LD14GDN ISION
PLAN REVIEW
❑ New construction ' ' ddition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
u� ❑ 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.
. - and 2 dwelling less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
tj,....
y g ❑ 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 ",
L_ r_ �� l� 1 �` y� Six or or more. occupancy.
Job no.: Job site address:
\ `l5J W ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ' ` P- C ❑ 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
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
1 _ 1 �'D Limited energy, multi- family
Ft i r �.,) �. Y �/� J 1 P Ujac INS' C.c i residential (with above sq. ft.) 75.00 2
1 Services or feeders installation, alteration, and/or relocation
£6 7 t f. L ( ^ W 'tJ - C. C clt Q (rA _ , ,,, /�- "s. C 0 AcaSS 200 amps or less 100.70 2
` ❑ PROPERTY OWNER ` e ❑ TENANT 201 amps to 400 amps 133.56 It 2
1 � p � 401 amps to 600 amps 200.34 2
Name: ( _1 . t S W ( C) /t- U t 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
n 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
ty 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
panel, alteration, or extension. Page 2 2
Business name:
S 1�C . CV l . �'V L Each additional inspection over allowable in any of the above
Address: p x p,4 It 1 c-2 ( Additional inspection (1 hr min) 66.25/ hr
�� >> Investigation (1 hr min) 66.25/ hr
City/State /ZIP: ( (CSC wt.0 S d R--- q ', F, f 5 Industrial plant (1 hr min) 78.18/ hr
Phone: ( O 6 Fax: ( ) Inspections for which no fee is
S �) ' 6, specifically listed (%: hr min) 90.00 / hr
CCB Lic.: j' D 1 y 3 Electrical Lic.: C 1 6 / Suprv. Lic.: 5 S"'' f ELECTRICAL PERMIT FEES
/ Subtotal:
Suprv. Electrician signature, r uired: • A on I Plan review (25% of permit fee):
Print name: • �� d v- �� „if t ate: �. 1 6 , // t State surcharge (12% of permit fee):
/ ((( TOTAL PERMIT FEE: 7 (. 2.3
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: • days after it has been accepted as complete.
f Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(I I /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*
El Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
El Other:
C COMMERCIAL WORK ONLY: -
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
El Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
❑. Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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