Permit CITY OF TIGARD ELECTRICAL PERMIT
"'• 111 COMMUNITY DEVELOPMENT Permit #: ELC2013 -00293
T'GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/28/2013
Parcel: 251 02C D00100
Jurisdiction: Tigard
Site address: 9670 SW FREWING ST
Project: Keerins Subdivision: FREWING'S ORCHARD TRACTS Lot: 17
Project Description: Repair meter base due to tree strike.
Contractor: DICKINSONS ELECTRIC Owner: KEERINS, HERMAN & PATRICIA JOINT
8449 SW BARBUR BLVD 12195 SW 121ST AVE
PORTLAND, OR 97217 TIGARD, OR 97223
PHONE: 503 - 246 -3550 PHONE:
FAX: 503 - 213 -6049
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 05/28/2013 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 05/28/2013 $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 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 a - - I 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. A NTION: Oregon - requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 -0010 thro eh OAR 952 -0: - 00 :0 ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or_. 3•
Is 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'
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 Applic . u aft cENED FOR OFFICE USE ONLY
City of Tigard R tved r ry y • Pe No.: �r 3 City Date/By: '2 PO / { E L. —O' / J �ZU
I II 13125 SW Hall Blvd., Tigard,0 223 Plan Review \
e Phone: 503.718.2439 Fax: 503.59>�� ) 2 8 2O�3 Date/By: Other Permit:
l l c; A R ll Inspection Line: 503.639.4175 Date Ready/By: Juris HI See Page 2 for
Internet: www.tigard- or.gov Gt OFTIGARD Notified/Method: Supplemental Information
TYPE ( TNG DIVISION PLAN REVIEW
El New construction ddition/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
jai- 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
A
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "l -3 ",
�' / ^7 100HP or more. occupancy.
Job no.: Job site address:
�' ' /Q r�e,u� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Ei 0 `j ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. I Total I •
L 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
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
n Limited energy, multi- family
e -A r , � Tice ‘ j /v - residential (with above sq. ft.) 75.00 2
' "✓ /�/ / "'ems Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and/or relocation _
‘IpROPERTY OWNER I ❑ TENANT 200 amps or less / 100.70 4:',0 • 2
201 amps to 400 amps 133.56 2
Name: li cf e 21 f) S 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
Phone: ( ) Fax: ( ) relocation
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 _
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: I each branch circuit
/ B. Fee for branch circuits without
Contact name: service or feeder fee, first
branch circuit 56.18 2
Address: Each add'l branch circuit 7.42 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
Phone: ( ) Fax: : ( ) dwelling, service and/or feeder
Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: / ! c„..4.,. Signal circuit(s) or limited - energy See
s� panel, alteration, or extension. Page 2 2
Address:'Lfc( L S t:c/' 6 k Each additional inspection over allowable in any of the above
/� �f / Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: p �, /� / v /`� Q> / Investigation (I hr min) 66.25/ hr
Phone: Cco ) ) G 3 $ ' 7 Fax: / 3 Industrial plant (1 hr min) 78.18/ hr
z Inspections for which no fee is
CCB Lic. ' j y Electrical LR G�!/( Suprv. Lic.: ; 3� S specifically listed ('h hr min) 90.00 / hr
Suprv. Electrician signature, requi ) : l ELECTRICAL PERMIT FEES
/ Subtotal: Boa • 70
Print name: ' Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): / 2 , Og
Authorized signature: TOTAL PERMIT FEE: // a • 7g
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
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Electrical Permit Application — City of Tigard S ..
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Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY:
FEE 'SCHEDULE .—
Fee for all residential systems combined ... $75.00 Description I otv. I Fee I Total I
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
El Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
El Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
El Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva (fee in accordance with 552.26 2
OAR 918- 309 -0040)
❑ Heating, Ventilation and Air Conditioning
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System* Solari generation systems in excess of 25 kva:
Each additional kva over25 7.42 3
❑ Vacuum Systems* >100 kva– no additional charge 0.0 3
El Other: additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly (I hr min) 66.25/ hr I
Inspections for which no fee is
specifically listed (t4 hr min) 90.00/ hr
COMMERCIAL WORK ONLY •ELECTRICAL PERMIT FEES,
Fee for each commercial system $75.00 Subtotal:
(SEE_ OAR 91 8- 309 -0000) Plan review, if required (25% of permit fee):
State surcharge (12% of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
El Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
El Boiler Controls
El Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
El Instrumentation •
El Intercom and Paging Systems
El Landscape Irrigation Control*
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❑ Medical •
El .Nurse Calls
El Outdoor Landscape Lighting* '.
El Protective Signaling •
El Other --
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• Total number of commercial systems:
*NO are required. Licenses are required •
for all other installations
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