Permit . n CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELC2013 -00167
TIGARD, 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/14/2013
Parcel: 1 S 135CA01900
Jurisdiction: Tigard
Site address: 11330 SW 97TH CT
Project: Wadleigh Subdivision::HERS ADDITION TO GREENBURG HE Lot: 1
Project Description: Relocate existing panel
Contractor: SOLID ROCK ELECTRIC LLC Owner: WADLEIGH, TAMERA
5170 KHYBER AVE SE 11330 -11334 SW 97TH CT
SALEM, OR 97306 TIGARD, OR 97223
PHONE: 503 - 931 -6306 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 03/14/2013 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 03/14/2013 $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 iss 'ect 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 rdance with - .proved 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. A ENTION: Oregon la -qui = you to follow the rules adopted by the Oregon Utility Notification Center. Those ' rules are set forth in OAR
952 -00 -0010 thro gh OAR 9520- 009�Yo ay obtain a copy of the rules or direct questions to OUNC by calling 503,232.19 7 r 00. 44,
Iss ed By: 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' /el ! I Date: /"L./ // 5
LICENSE NO. 56) ( S /
Call 603.639.4175 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 ,
City of Tigard Date/By: ,�( oe r Y 1 J ./ Permit No.: EZ—e t 5 — c ) �CO 7
y:
1111
13125 SW Hall Blvd., Tigard, OR 97223 Plan Rev iew
II • Phone: 503.718.2439 Fax: 503.598.1960 DateB Other Permit:
TI tG A R D Inspection Line: 503.639.4175 Date Ready/By: Juris Vi See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK 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 - ", "I - ",
Job no.: Job site address: ` \ 33 5 9 1-P'" C.4 100HP or more. occupancy.
❑Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: -r' ,',5 �& De_ ❑ Health -care facilities.
0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ( JP-1) L E. (a 0 ❑ 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
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
(with above sq. ft. 75.00 2
DESCRIPTION OF WORK e ( q )
p l Limited energy, multi - family 75.00 2
4 '� ( 2./‹; O t - "1 . k�o p7C r�1 +0 1') Iii Ck_ C (AR, (I residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less ` 100.70 J00 , 2
ID PROPERTY OWNER ❑ TENANT _ 201 amps to 400 amps I 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
y 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, 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: l ,, , ` B. Fee for branch circuits without
d \ L "` x � i ` service or feeder fee, first
'1\__.,..4.4. \ n branch circuit 56.18 2
Contact name: ' I
Each add'l branch circuit 7.42 2
Address: 51+0 14 b f Av S Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State /ZIP: (, — �7 c1
`' 'v , U� / .1- 3 d ( ' dwelling, service and/or feeder 67.84 2
Phone: (5753 ) 93/ -( C. Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Set' /Zo ... c f e ...., iti Cc. ..
Signor outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: S c ' El Q2hnZ I` panel, alteration, or extension. Paget 2
Each additional inspection over allowable in any of the above
Address: 5 - 1 (e/ILli ,rt AL7C CZ Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: ,�,�M// Investigation (1 hr min) 66.25/ hr
Se._ or Z.. S T3QL Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) 9-2,/ 3 d Fax: ( ) Inspections for which no fee is
+ .0 71//f4 �� /� % specifically listed (/2 hr min) 90.00 / hr
CCB Lic.: (? Electrical Lic.: C7_ 5---e( Suprv. Lie.: ,/ ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: /9/-1,/4N-- Plan Subtotal: / review (25% of permit fee):
Print name: /Vd744. / `'" �„ "`'/ Date: 3/`y// State surcharge (12% of permit fee): i -O g
� t � TOTAL PERMIT FEE: // ¢ - 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: ile/ H C / P Date: �/j i/ / 3 * Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440 -4615T(I1 /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*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
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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
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