Permit CITY OF TIGARD ELECTRICAL PERMIT
114 ss COMMUNITY DEVELOPMENT Permit#: ELC2013-00511
T f CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/27/2013
Parcel: 2S110DD01600
Jurisdiction: Tigard
Site address: 10415 SW CENTURY OAK DR
Project: IMUS Subdivision: SUMMERFIELD Lot: 23
Project Description: Panel replacement and ground rod installation.
Contractor: TDS ELECTRICAL CONTRS. Owner: IMUS,CHARLES W&GLENDA J
PO BOX 1521 10415 SW CENTURY OAK DR
CLACKAMAS,OR 97015 TIGARD,OR 97224
PHONE: 503-710-0866 PHONE:
FAX: 503-698-4519
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 08/27/2013 $100.70
Specifics: amps or less
1 crt Branch Circuits w/Purchase 08/27/2013 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 08/27/2013 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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 susiiended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. • nie/r= set forth in OAR
952-001-0010 throe R 952-001-0090. Yo les ora questions to OUNC by calling 503.2 .1987 or 1/010
Issued B . Permi .Signature:
C �
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 603.639.4175 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 `lam � FoR 0H:icy ICI uSl■ ONl.\
City of Tigard y Date/By: ���-7�/3 j� Permit No.: g�� 3—00��/
q 13125 SW Hall Blvd.,Tigard,OR c' 013 Plan Review
III Phone: 503.718.2439 Fax: 503. 98.196QQ �� Date/By: Other Permit:
Inspection Line: 503.639.4175 W‘ r Date Ready/By: Saris: ® See Page 2 for
l IGAI D v
Internet: www.tigard or.gov 1�`ClQ Notified/Method: . � Supplemental Information
TYPE OF W tAG� 1 PLAN REVIEW
❑New construction Addition/alter9Palacement 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 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
Multi-family El Master builder 0 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","1-3",
Job no.: Job site address: 101-1 (S S W C eh it� \i Six or or more. Recreational
❑Six or more residential units. ❑Rr vehicle parks.
City/State/ZIP: `r 4v t\ o 2 ❑Healthcare facilities. 0 Supply voltage for more than/ ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: i- S ❑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'1500 sq.ft.or portion 33.92 1
Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 75.00 2
l4 Csk_ i s--t, c wh v` / Nti \,,vot.\ residential(with above sq.ft.)
_ Renewable Energy _ ❑ See Page 2
l h S kq\1 (SY0-Av—� v�A,5 Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER I 5 ❑ TENANT 200 amps or less i 100.70 /4),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 r 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 ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, 7.42 7 yQ 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'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
Business name: —r- � Signal circuit(s)or limited-energy See
t U S L�• ��/'s S panel,alteration,or extension. Pie 2 - 2
Address: P is 6 6 `t5-1` Each additional inspection over allowable in any of the above
City/State/ZIP: Q Additional inspection(I hr min) 66.25/hr
City/State/ZIP: c2 c_� �
�n .s Investigation(1 hr min) 66.25/hr
Phone:(563) '7 fa O g 6, (, Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 1-7b19 3 Electrical Lie.: C 1 (s.Lk Lic.: 53 S�S specifically listed(V2 hr min)
Suprv.Electrician signature,required: ` ELECTRICAL PERMIT FEES -
-- Subtotal: ./o g,/,/
Print name: ,��� SG Lfrt1.6.),..... D ate: 9 12,-)
Plan review(25n%of permit fee):State surcharge(12/o of permit fee): /d. 1
Authorized signature: TOTAL PERMIT FEE: /A I,Oy
This permit application expires if a permit is not obtained within(80
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC PemtitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(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
OAR 918-309-0040) 552.26 2
❑ Heating,Ventilation and Air Conditioning
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:
❑ 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(V2 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 .
C\Building\Pennits\ELC_PermitApp ELR ERE.doc Rev 05/21/2013