Permit CITY OF TIGARD ELECTRICAL PERMIT
'F COMMUNITY DEVELOPMENT Permit#: ELC2013 00458
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/05/2013
Parcel: 25111 BC00700
Jurisdiction: Tigard
Site address: 10135 SW INEZ ST
Project: McBride Subdivision: TIGARDVILLE HEIGHTS Lot: PTS 18-
Project Description: Install ground rods due to water service replacement.
Contractor: DICKINSONS ELECTRIC Owner: MCBRIDE,GLEN W&
8449 SW BARBUR BLVD JANET HALL
PORTLAND, OR 97217 10135 SW INEZ
TIGARD,OR 97224
PHONE: 503-246-3550 PHONE: 503-639-0030
FAX: 503-213-6049
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 08/05/2013 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/05/2013 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 accordan 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. ATTEN N: Orego Jaw requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-00 through OAR 952001-1'-3. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.814_,32.
Issued y: f � � //�% _ 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 503.639.4175 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 App licattECEIVED FOR OFFICE USE ONLY
City of Tigard Dateived i a�a• Permit No.: eie py�y,3—[�C./ Sg
13125 SW Hall Blvd.,Tigard,OR 9 5 2013 l
' a .- Phone: 503.718.2439 Fax: 503.598.1960 Date/By:Review Other Permit: PLN�//j—Q0�56)
T l G F lJ Inspection Line: 503.639.4175 CITY OFTIGARD Date Ready/By: Juris: 1 See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK • PLAN REVIEW
El New construction 1 ,'A/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
d 2-family dwelling ❑Commercial/industrial ❑Accessory build 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.
❑Addition of new motor load of ❑"A","E","1-2","I-3",
Job no.: Job site address: J J IOOHP or more. occupancy.
/ 0 / 5 i Ll?j ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: eJ ❑Health-care facilities. 0 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. I Fee. I Total
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
(2; /et Ale,,,,) W(
Limited energy,multi-family th aove q. 75.00 2
residential(with above sq.ft.)
- Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER I ❑ ANT 200 amps or less 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 snips 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
■ APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with
-- above service or feeder fee,
7.42 2
Business name: each branch circuit
B.Fee for branch circuits without ,9
Contact name: service or feeder fee,first 56.18 6-&/ 2
branch circuit
Address: Each add'I 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
/� L l, Signal circuit(s)or limited-energy See
Business name: // �w /S f' � panel,alteration,or extension. Page 2 2
Address: �L�q g 6 r;� 13G� ,,g 4,,,..e,-- Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: ,P��z �i Og 5 -? �?3 Investigation(1 hr min) 66.25/hr • .
Phone:(5(2-g A I/6 3 61 ,5"-C, Fax: >l7 r / -631 - Industrial plant(1 hr min) 78.18/hr
�/ Inspections for which no fee is 90.00/hr
CCB Lic.:6 5�-"5'% ,,Electrical Lic.: 6 rL Suprv.Lic. 4�—ps specifically listed(/2 hr min)
t t t
•Suprv.Electrician signature r- t� ELECTRICAL PERMIT FEES
Subtotal: /0,(o
'�
Print name: Date: Plan review(25%of permit fee):
State surcharge(12%of permit fee): (p•7 L'
Authorized signature: TOTAL PERMIT FEE: (pd%.
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:\Building\Permits\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 over25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ 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(V 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.
❑ 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
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