Permit 111 a CITY OF TIGAR ELECTRICAL PERMIT
COMMUNITY DEVELOPME Permit #: ELC2013 00380
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/08/2013
Parcel: 25111 DC12800
Jurisdiction: Tigard
Site address: 15955 SW OAK MEADOW LN
Project: Wilson Subdivision: SUMMERFIELD NO.11 Lot: 624
Project Description: (1) 200 amp service panel change
Contractor: IMAGINE ENERGY LLC Owner: WILSON, RUTH ANN
2409 N KERBY 15955 SW OAK MEADOW LN
PORTLAND, OR 97227 TIGARD, OR 97224
PHONE: 503 - 547 -3684 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/08/2013 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 07/08/2013 $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 accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work i suspe ded for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. , Those rules are set forth in OAR
952- 001 -0010 through OAR -00 . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987r 1.800.33 ,.2344
Issued By: / l.V 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 503.639.4176 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 Applicatio ED FOR OFFICE USE ONLY
I
Da teeBiyy: �/(].(� Permit No.: 6-46,2042 - D 3 h)
City of Tigard Re 7 4 / Ji
13125 SW Hall Blvd., Tigard, OR 97223 . Plan Review
' .: II Phone: 503.718.2439 Fax: 503.598.1960 � ll g DateBy: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: ® See Page 2 for
Internet: www.tigard lIC h IJ g CITY OFTIGARD Notified/Method: 71 Supplemental �� icy � �t/^� t1 Information
' E OF. W+OR# DIVISION . '' ;PLAN 'REVIEW ■
❑ New construction g 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
D1 and 2- farriily dwelling ❑ CommerciaUindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 150 KVA or
.JOB ',SITE 'INFORMATION A ND'SLOCATION , ' ❑ Emergency system. larger separately derived system.
/ i ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
,./ Job no.: Job site address: I OOHP or more. occupancy.
1 5 1.55 i„,.( D1 ` I ' � ,t J ou/ - N . ❑ Six or more residential units. 0 Recreational vehicle parks.
City/State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
t [ sh` Y J 0 t 2 y 7 2 2 "f ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.:' Project name: ❑ Service or feeder 600 amps or more.
� .
' `: FE '
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'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
Limited energy, multi - family 75.00 2
,r ` E C --rte . r it t..._ G I r t T' ?�'t may_ G4}hnt Cat; - . residential (with above sq. ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and/or relocation
❑ oPROPERTY OWNER . " , .❑ TENANT 200 amps or less i 100.70 2
201 amps to 400 amps 133.56 2
Name: 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
I ❑ , CONTACT PERSON . .. ' A. Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
I nt AG t r. IC. 1- PJ .Nlr t e B. Fee for branch circuits without
Contact name: �� • service or feeder fee, first
1 ,, h .> ,r1'n0 r < .. branch circuit 56.18 2
4. Address: -Z y c l �Z.�a__ . Each add'l branch circuit 7.42 2
t o p Miscellaneous (service or feeder not included)
City/State/ZIP: t5 / - 1 72.2..7 Each manufactured or modular
l t �
' dwelling, service and/or feeder 67.84 2
l
Phone: (5O ' $ u 7 . 3c k u Fax: : ( ) Reconnect only 67.84 2
E -mail: 1 / 1 0.... ��
—. a J , NI-1-6 ,a S C� t� 4-.4 Fr ,..4:: , Pump or irrigation circle 67.84 2
, CONTRACTOR . . , ! Sign or outline lighting 67.84 2
Signal circuit(s) or limited- energy See
Business name: panel, alteration, or extension. Pa' e 2 2
Address: Each additional inspection over allowable in any of the above
Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Phone: ( ) Fax: ( Industrial plant (1 hr min) 78.18/ hr - 7 / pil d I I Inspections for which no fee is
I CCB Lic.: 1 6 7 q / 3 Electrical Lic.: 2 Su prv. Lic.: O C specifically listed ( hr min) 90.00 / hr
l b 7 r S .ELECTRICAL ..PERMIT TEES :• j
S uprv. Electrician signature, required: _ �' l Subtotal:
Print name: Date: v Plan review (25% of permit fee):
••••—r , '.7 �H' -S 7 • tJ • 1 3 State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: /4e2 , 7P'
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.
1: \Building\ Perini ts\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 4404615T(11/05/COM/WEB
•
Electrical Permit Application — City of Tigard
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 Qty. 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
❑ Audio and Stereo Systems*
15.01 to 25 kva 200.34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva: _
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva (fee in accordance with 552.26 2
El Heating, Ventilation and Air Conditioning OAR 918- 309 -0040)
System* Solar generation systems in excess of 25 kva:
'Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva— no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
El Other: Each additional inspection is
charged at an hourly (1 hr min) 66.25/ hr 1
Inspections for which no fee is 90.00/ hr
specifically listed (V0 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918- 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
❑ Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
El Boiler Controls
❑ Clock Systems •
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
•
El Intercom and Paging Systems
El Landscape Irrigation Control*
El 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_ELR_ERE.dac Rev 05/21/2013