Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit#: ELC2013-00473
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/08/2013
T t G t\R.jD g Parcel: 1 S 134CD03700
Jurisdiction: Tigard
Site address: 11960 SW 121ST AVE
Project: Durrett Subdivision: LERON HEIGHTS NO.3 Lot: 71
Project Description: Reconnect only.
Contractor: OWNER Owner: DURRETT, BARBARA P
11960 SW 121ST
TIGARD,OR 97223
PHONE: PHONE: 503-348-8578
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 08/08/2013 $67.84
Specifics:,
1 ea 12%State Surcharge- 08/08/2013 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 is suspended 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• ' 1-0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ' i Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on prope I own w ich is no ed for sale,lease or rent. �+
OWNER'S SIGNATURE \ /�G�:!/ Ate. . 1 012J Date: ZS
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 Application RECEIVED
p FOR OFFICE USE ONLY
AUG 8 203 Received
Ci}�, of Tigard a Permit No.: l
`J g DateBy: e�4 /� T� �t%��/3 y�/
v 13125 SW Hall Blvd.,Tigard,OR 9722 �+�/ Plan Review
'� Phone: 503.718.2439 Fax: 503.598.1b11OFTIGARD Other Permit:
Date/13y:
-l:I AI.I) Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: Juris: �/ ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: 776 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
❑ I-and 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 - 13 Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","1-2","I-3",
5 /� 100HP or more. occupancy.
Job no.: Job site address://969 [e/ /S ❑Six or more residential units. ❑Recreational vehicle parks.
(�- City/State/ZIP: —77 4 (J 2 l ❑Health-care facilities. ❑Supply voltage for more than
J y ���� ❑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 I *
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: - Lot no.: 1,000 sq..ft.or less 168.54 ' 4
Tax map/parcel no.: Ea.add'I 500 sq.R.or portion 33.92 I
Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
-_ Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
•
- . . PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2
�) � a ' `^,, 201 amps to 400 amps 133.56 2
Name: /z , ,«e7! 401 amps to 600 amps 200.34 2
Address: //964) S /02ls f 4 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: ,6'412.0 6), 7%2.23 Temporary services or feeders installation,alteration,and/or
Phone: )3)3y� 5�t Fax:( ) relocation
200 amps or less 59.36 I
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, e,rent,o exchan ccording t S 447,449,670, 401 amps to 599 amps 168.54 2_
Owner signatu Date: Branch circuits—new,alteration,or extension,per panel
' ❑ APPLICANT' ' .❑,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
Contact name: service or feeder fee,first 56.18 2
branch circuit
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
only 1 67.84 2
E-mail: Pump or irrigation circle 67.84 2
' ,CONTRACTOR,_ , ," Signor outline lighting 67.84 2
Business name:
Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: Each additional inspection over allowable in any of the above
Additional inspection(t hr min) 66.25/hr
City/State/ZIP: Investigation(I hr min) 66.25/hr
Phone:( ) Fax:( ) Industrial plant(1 hr min) 78.18/hr -
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lie.: specifically listed(1/2 hr min) _
ELECTRICAL PERMIT'FEES •
Suprv.Electrician signature,required: Subtotal:
Print name: Date: Plan review(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: "25 7,/
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
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 on. 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
ElAlarm 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
•ElOther: 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
Inspections for which no fee is 90.00/hr
specifically listed(Y hr min)
COIVIlVIERCIAL WORK ONLY: ELECTRICAL PERMIT'FEES -
Fee for each commercial system $75.00 Subtotal:
•(SEE OAR 9187309-0000) 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
I:\Building\Permits\ELC_PermilApp_ELR_ERE.doc Rev 05/21/2013