Permit CITY OF TIGARD ELECTRICAL PERMIT
illq • COMMUNITY DEVELOPMENT ELECTRICAL
ELC2012 -00725
13125 SW Hall Blvd., Tigard OR 97223 503,718.2439 Date Issued: 12/19/2012
T I t; r1 K i7 g Parcel: 25111 CA11800
Jurisdiction: Tigard
Site address: 9765 SW OAKS LN
Project: Klein Subdivision: SATTLER PARK Lot: 3
Project Description: (3) branch circuits for new wiring to added wall, entry and kitchen alcove
Contractor: TDS ELECTRICAL CONTRS. Owner: KLEIN, CINDY
PO BOX 1521 9765 SW OAKS LN
CLACKAMAS, OR 97015 TIGARD, OR 97224
PHONE: 503 - 710 -0866 PHONE:
FAX: 503 - 698 -4519
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 12/19/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/19/2012 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 1 -w. 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 i ' spe for ore the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Th• ule1=r- ■ - "orth in OAR
952- 001 -0010 through OA 52 -001- 90. You may obtain py of the rules or direct questions to OUNC by calling 503.2 .1987 or 1? 2 4104.000„.
,
Issued By: ill w` Permittee Signature: • .—r
�"
OWNER INSTALLATION ONLY
The installation is being made on pr. - rty I own which is • tend:. or sal =se or
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 ApplicationRE EIVED FOR OFFICE: 1 O \1.1
City of Tigard Received /?-- / $. Permit No.: 1 -0p o j
13125 SW Hall Blvd., Tigard,OR 97223 ! 9 2012 7 / ��
g 1 9 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
I 1 e i 1 , I
Inspection Line: 503.639.4175 Date Read /B Juno; / ® See Page 2 for
Internet: www.tigard- or.gov CITY OFTIGARD TIGARD No t ified/Method: / (7 Supplemental Information
BUILDING DIVISION
TYPE OF WORK PLAN REVIEW
El New construction lition/alteration/replacement Please check all that apply (submit 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
I - 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: T'7 (0 $ S' Lk. Q Ait_5 at l NA L 100HP or more. occupancy.
Six or more residential units. 0 vehicle parks.
City/State/ZIP: e / fG Q 0- ❑ 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. 1 Fee. I Total 1
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'( 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
_ Limited energy, multi- family
75.00 2
I v 1-/ A-1 (�,,,\ ft�C Q cP �� . � '� r residential (with above sq. ft.)
F11 J \ 1 u / Services or feeders installation, alteration, and/or relocation
j\�(� V i e i\A CaV e___ 200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: I t^ r 1 1 601 amps to 1,000 amps 301.04 2
Address: ei 7 6, - L „_ i o k S ' ( 12—.._ Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, altera tion, and /or
City/State /ZIP: 'r, rte, O (2--- 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, pe r panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, — 7.42 2
each branch circuit
Business name: 13. Fee for branch circuits without
service or feeder fee, first 1 2
Contact name: branch circuit 56.18
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
.�e� panel, alteration, or extension. _ Page 2 - 2
Business name:
t S cc- ' C c„J-i S Each additional inspection over allowable in any of the above
Address: pc, F e } c Z l Additional inspection (1 hr min) 66.25/ hr
G
City /State /ZIP: I "� t Investigation (1 hr min) 66.25/ hr
C C C �"o f Q Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed (%: hr min) 90.00 / hr
CCB Lie.: 1 '7 D/ 4) Electrical Lie.: C / (a 9 Suprv. Lic.: r 5-1 S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: o Subtotal:
..,..,___,Brf Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee):
TOTAL PERMIT FEE: 7q. 53
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.
N um b er of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doe 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*
❑ Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
❑ 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
El Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
p Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
El 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
1
\Building\Permits\ELC-PermitApp doc 07/01/10