Permit n CITY OF TIGARD ELECTRICAL PERMIT
_ COMMUNITY DEVELOPMEN Permit #: ELC2012 00680
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/03/2012
Parcel: 2S109DA14000
Jurisdiction: Tigard
Site address: 12677 SW MOUNT VISTA CT
Project: Rowe Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 59
Project Description: Install (1) sub panel and (8) branch circuits for basement wiring.
Contractor: SCHROEDER & SONS ELECTRIC Owner: ROWE, WILLIAM S & MARY J
PO BOX 748 PO BOX 409
BORING, OR 97009 CHEWELAH, WA 99109
PHONE: 503 - 939 -5108 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 12/03/2012 $100.70
Specifics: amps or less
8 crt Branch Circuits w /Purchase 12/03/2012 $59.36
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 12/03/2012 $19.21
Electrical
Type of Const:
Occupancy Grp:
Total $179.27
Required Items and Reports (Conditions)
This permit is ' ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ' accordance with :pproved 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. TENTION: Oregon 1 -w 1921,41res ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 -0010 t ough OAR 952 -0° 0090. ou ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss d By: I � Permittee Signature: 7� ..
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 Application FOR OFFICE USE ONLY
City of Ti and Re ceived
DateB /..g . _ i
}�, g Permit No.: n (�T
� ii � A I iQV
e 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
0 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
I' I G A R D 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
„R�lew construction' Addition / alteration /replacement
Please check all that apply (submit 2 sets of plans w /items checked below):
0 Service or feeder 400 amps or more 0 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
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: 1-7 `-e/-7 +] $ W yl/r DU" ,1 V 1 s t l ix or or more. occupancy.
• Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: `' ( M / ❑ Health -care facilities. ❑ Supply voltage for more than
1 "' � (' ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Rowe- ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 5/Jvvi ur,i l 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 I
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
W/t S (.5',J 4— tO / r 1 residential (with above sq. ft.)
�� Services or feeders installation, alteration, and/or relocation
200 amps or less / 100.70 /COM 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
h 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, er panel
Owner signature: Date: A. Fee for branch circuits ivith
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 �9 2
each branch circuit CJ
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit r
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State /ZIP: 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: 7 (Lc.) V S 'S v panel, alteration, or extension. Page 2 2
t / Each ,additional inspection over allowable in any of the above
Address: SCE . Cy ye Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City /State /ZIP: V r n" (, vK G' '2 U 0 Industrial plant (1 hr min) 78.18/ hr
Phone: U) Fax: Inspections for which no fee is
(� " ( ) specifically listed (%: hr min) 90.00 / hr
CCB Lic.:Lft 0D-7 Electrical Lic.: 3s r 3 �5 Suprv. Lic.: y/ <-2 S ELECTRICAL PERMIT FEES
3J, //y / _ �/r /� io // //3 Subtotal: I GD, b &
Suprv. Electric' r required: `�`7 q Plan review (25% of permit fee): —
Print name: b o>i 0 1 - S6,frii2p-c,42-`r Date: /Z 3 -) Z State surcharge (12% of permit fee): /9. At
TOTAL PERMIT FEE: /7 9. 2 7
Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections �J
allowed� permit.
I: Building \Pennits\ELC- PermitApp.doc 07/01 /10 440 -4615T(l1 /05 /COM/WEB et / 7 f v.. 3
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
1.\Building\Permits\ELC- PermitApp.doc 07/01/10