Permit CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit#: ELC2013 00615
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/15/2013
Parcel: 2S103CA05100
Jurisdiction: Tigard
Site address: 11510 SW TERRACE TRAILS DR
Project: MARTIN Subdivision: TERRACE TRAILS Lot: 1
Project Description: (1)branch circuit for furnace installation.
Contractor: OWNER Owner: MARTIN,JESSE&WHITNEY
11510 SW TERRACE TRAILS DR
TIGARD,OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 10/15/2013 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/15/2013 $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 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 ado•ted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You ma ob•i •• oft : - or dire •uestions to OUNC by calling 503.232.1 7 o 809-33 2944
Issued By Permittee Signature: �xV
•
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 Application FOR OFFICE USE.ONLY
V City of Tigard t, .� Date/Be: V l '.r i Permit No.: a C j( •
13125 SW Hall Blvd.,Tigard,0 = 22.E N ,„',
C • Phone: 503.718.2439 Fax: 503 . .,jjt ,,,, 5 d"�'° Da1e/By:Review Other Permit:�yt� 3�yy
Inspection Line: 503.639.4175 2 1'3 Date Ready/13y: Janis: la See Page 2 for
I'I L.A K D p Date Read ethod: Supplemental
Internet: www.tigard-or.gov I^'( 1 5 7.t pp emental Information
TYPE OF WORK 1 rsr.-11C �U ,• ,PLAN REVIEW '
❑New construction ❑Addition/alterae a�t 1<ri�\tiw Please check all that apply(submit 2 sets of plans w/items checked below):
lJ 6 t`� ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: `O 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
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION'AND!LOCATION El Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: Job site address://.5/o 5& jer,„„ To,”/ply Six or or more residential Recreational
❑Six or more residential units. ❑Rr vehicle parks.
City/State/ZIPi / 3 ❑Health-care facilities. ❑Supply voltage for more than
�ir dt ' ' s 600 volts nominal.
❑Hazardous locations.
Suite/bldg./apt.no.: Project name: 710ay..J ❑Service or feeder 600 amps or more.
—— FEE
Cross street/directions to job site: ,,s,, ��t>c�frO 4
j _ 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'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
r1 / Limited energy,multi-family 75.00 2
J,�I��l/e�1 C /fir/ ,.0 - 4,,,,,✓0'`� residential(with above sq.ft.)
1� Renewable Energy 1 ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
A`PROPERTY OWNER I ❑ TENANT - 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: s,_ n din 401 amps to 600 amps 200.34 2
Address: //3/b 55,,Te,-,d.c e_ 71 ,.4 ,h- 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:7-,--07/ai oQ 97,9,2 3 Temporary services or feeders installation,alteration,and/or
Phone:(503 ) ) relocation _
SO y 7 S7f7 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,lee,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: /f}/510/3 Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
APPLICANT '0 CONTACT PERSON above service or feeder fee, '
7.42 2
Business name: m1cw-- each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first
_ branch circuit 56.18 2
Address: Each add'I branch circuit ( 7.42 7,iv. 2
Miscellaneous(service or feeder not included)
City/State/ZIP: 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: • Signal circuit(s)or limited-energy See
�/w sC panel,alteration,or extension. Page 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(l hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(%3 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: _ Subtotal: ,Sr-6,(;
Print name: Date: Plan review(25%of permit fee): —
State surcharge(12%of permit fee): 6,1 7
Authorized signature: / TOTAL PERMIT FEE: Np s-Et
This permit application expires if a permit is not obtained within 180
Print name: Se5se/V1,.T 1-tN Date: /d../5_, 3 days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 44046t5T(II/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
ElOther: 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('h 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
ElAudio and Stereo Systems days after it has been accepted as complete.
Number of inspections allowed per permit.
❑ Boiler Controls
Cl Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ 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
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325(2))
This statement is required for residential building, electrical,mechanical,and plumbing per mits.
Licensed architect and engineer applicants,exempt from licensing under ORS 701.010(7), need not
submit this statement.This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
Print Name of Permit Applicant
/0-45-i3
ignature of Perms Applicant Date
Permit#: c f 3—do
i5
lJ Address: x 6-'10 344 � 7h.-
Issued by: 3 _ Date: /Ul/6113 - .
This Copy for Permit Offices