Permit ,71 CITY OF TIGARD ELECTRICAL PERMIT
° COMMUNITY DEVELOPMENT Permit #: ELC2010 -00068
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/10/2010
Parcel: 2S102AA03300
Jurisdiction: Tigard
Site address: 12265 SW HALL BLVD 1
Subdivision: Lot: 0
Project: Williamsburg Apartments
Project Description: (1) hour of inspection time to inspect the splicing of aluminum to copper in outlets in all units.
Owner: FEES
SKOURTES, MARIANELLY Quantity Description Date Amount
PO BOX 2327
CLACKAMAS, OR 97015 1 hr Hourly Electrical Rate 02/10/2010 $90.00
PHONE: 1 ea Hourly Electrical 12% 02/10/2010 $10.80
Surcharge
Contractor:
ELECTRO WIRE INC
18857 SE SUNNYSIDE RD
BORING, OR 97009 -9271
PHONE: 503 - 658 -8136
FAX: 503 - 658 -7019
Type of Use: MF
Class of Work: OTR Type of Const:
Occupancy Grp:
Total $100.80
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 acco with approved 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. ATT ION: Orego =w re•uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 - 10 through OAR 952 -0. -' 10' Y . ay obtain a copy of the rules or direct questions to OUNC by calling 1 5 . 0 . 3.246.6699 or 1.800.332.2344.
Issu d By: ! � � ! r /aL Permittee Signature' 7C
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: Z! /o -/
LICENSE NO.
Call 803.839.4175 by 7:00 a.m. for an inspection that business day.
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.
ki rF
Electrical Permit Application i )R officl HSe ONLY
City of Tigard Received / Permit No.:
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review w �t7 F�o�O�D�
'� C Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
r i C. n is D Inspection Line: 503.639.4175 Date Ready/By: Jun ' ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: ■ / f U Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit a sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition or 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.
iilt 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 ", "I -2 ", "1 -3 ",
Job no.: Job site address: /2 C p I OOHP or more. occupancy.
G 2_�� J S�r'� 171 -NO� 0 Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP:
7944 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. n. I 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: I 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 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
% Limited energy, multi - family
67.84 2
J�� f 7 (��
) , dfi j 6-G _ residential (with above sq. ft.)
/r Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
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
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 _ 2
Owner signature: Date: Branch circuits – new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 56.18 2
first branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( )
Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: 7 G � .� , Signal energy panel p a nel t(s) or limited -
, alteration, or
Address: /2)/_ 7 5 , extension. Describe: Page 2 2
City /State/ZIP: �,� , , /D 9 isth C� Each additional inspection over allowable in any of the above
Phone: � / Per inspection 66.25
-�) 1 Fax: )6.5.6- 19 Investigation per hour (I hr min) 66.25
Electrical Lic.: Suprv. Lic.:
90, "' ;848- yd,�
CCB Lic.
�- `1071= 107 p z 7 17 flouigc
--�/�- /.,//I =CAL PERMIT FEES �
Suprv. Electrician signature, required i� 0/ �LGGL- [ta E2,,g2/d13z Subtotal: 9/ Q
Print name: Date: Plan review (25% of permit fee): -. --
State surcharge (12% of permit fee): #e) • 170
Authorized signature: TOTAL PERMIT FEE: /DO - To
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: BBuilding \Pennits\ELC- PermitApp.doc 10/01 /09 440.4615T(11/05/COM/WEB
r• �
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $67.84
Check Type of Work Involved:
El 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 $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
El Instrumentation
p Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
E l Nurse Calls
El 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 10/01/09