Permit q CITY OF TIGARD ELECTRICAL PERMIT
111 COMMUNITY DEVELOPMENT Permit #: ELC2012 00693
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 12/11/2012
Parcel: 25111 BA01700
Jurisdiction: Tigard
Site address: 14325 SW 97TH AVE
Project: Mitchell Subdivision:CONDO SUPPLEMENTAL PLAT NO.3: Lot: 32
Project Description: (2) 200 amps or less for Heat Pump and (2) branch circuits for fire alarm and electrical main panel replacement
Contractor: i„ 1 11 Owner: MITCHELL, PATICIA
�/ 14325 SW 97TH AVE
TIGARD, OR 97224
PHONE:
PHONE. 503 - 620 -3203
FAX:
FEES
Quantity Description Date Amount
2 ea Services or Feeders - 200 12/11/2012 $201.40
Specifics: amps or less
2 crt Branch Circuits w /Purchase 12/11/2012 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 12/11/2012 $25.95
Electrical
Type of Const:
Occupancy Grp:
Total $242 19
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 su - nded for more the 180
days. ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rul/ are set forth in OAR
952 - 001 -0010 through OAR 2 01 -009 Pt/ may obtain a copy f the rules or direct questions to OUNC by calling 503 2 1987 or 1 800 33
Y . 4
Issued By: OAR
�\ f 2 Permittee Signature:
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 1 st: om.)
City of Tigard �� II Received (� � Permit No L ' (� _
Date/By: (. (' S
a L C) h� �P
l
13125 SW Hall Blvd., Tigard, OR 97223 1 1 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 DEC 1 1 2012 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date ReadyBy: J ® See Page 2 for
Internet: www.tigard -or.gov p� CITY OF TIG R Notified/Method: Supplemental Information
TYPE OF Wa#LLING DIVISION PLAN REVIEW
❑ New construction 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
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 ", "1 -2 ", "1 -3 ",
Job no.: 1 Job site address: ? 5 O� / Y.\ I00HP or more. occupancy.
J ' J S W 7 0 Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 7 �J ❑ Health - care facilities. ❑ Supply voltage for more than
�� 1'\\ Y �� Z v � ) ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: M., k 'r r✓ _ L� //"� ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Mil/VOC.ZG / /1C ( jy ��/r o Description I Qty. I Fee. I Total
/ _ � / 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.)
I) Z—w v047 tt Brp cvitcifi t 4,- f ekr OAP /NSI` C� Limited energy, multi- family 75.00 2
residential (with above sq. ft.)
1M
' / ` Gr �- Q Services or feeders installation, alteration, and/or relocation
z. w - w/ X67 -F/ xe 10,11 / f ee- J s'ei � �N / WL / 0 amps or less 100.70 2
❑ PROPERTY OWNER / ❑ TENANT /t, dire 201 amps to 400 amps 133.56 2
(r 401 amps to 600 amps 200.34 2
Name: `I9 /CAM- ot/ m'. e
601 amps to 1,000 amps 301.04 2
Address: / tef5 L s Sct/ / 7 7'"` Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: /� 6 , 0x , 6 a ,. q vz 7
l / relocation
Phone: (So3) { Z.c) 3 4 3 Fax: ( ) '200 amps or less . 59.36
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 cco di g to O 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: /Z - — / L A. Fee for branch circuits with
- APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2 /
each branch circuit
Business name: S - #0 t B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l 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: 5fritt.31 panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State /ZIP: Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed (%2 hr min) 90.00 / hr
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Date: (Z - 1 1 - /Z— State surcharge (12% of permit fee):
OW' TOTAL PERMIT FEE: ) 9
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 allowed per permit.
I: \Building\Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(11/05 /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*
❑ Vacuum Systems*
El Other:
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
E l Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Budding'Permns\ELC- PermiApp doc 07/01/10