Permit 1 - q CITY OF TIGARD ELECTRICAL PERMIT
11. ' COMMUNITY DEVELOPMENT Permit#: ELC2013 00621
TIGARD 13125 SW Hall Blvd,Tigard OR 97223 503.718.2439 Date Issued: 10/21/2013
Parcel: 2S 104CA09000
Jurisdiction: Tigard
Site address: 13427 SW 136TH PL
Project: Brousseau Subdivision: HILLSHIRE Lot: 90
Project Description: (2)branch circuits for bathroom remodel.(Canned lights and exhaust fans)
Contractor: OWNER Owner: BROUSSEAU, ERIC M
BROUSSEAU, ERIC&NICOLE 13427 SW 136TH PL
13427 SW 136TH PL TIGARD,OR 97223
TIGARD, OR 97223
PHONE. 612-384-8239 PHONE 612-384-8239
FAX.
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 10/21/2013 $63 60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/21/2013 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 accord 'h 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 Oregon aw re•uires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR/952-001-00 thro gh OAR 952- I -8 09e. may obtain a copy of the rules or direct questions to OUNC by calling 5 232. :7• 1 800 332 2344.r /
Issue By: 0
/' Permittee Signature: / "' 1 / / • ,
OWNER INSTALLATION ONLY
The installation is being made on•rope,•• o-w/n whic is not ten•_•for sale,lease or rent /1 2
OWNER'S SIGNATURE �� /� ��_ Date: If/� b J
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 Applicatio E p ivL FOR of :ici IJSE''ON�Lv
Received �^�
III City of Tigard 212013 Date/By
hp/a/ t5 \fp/ Permit No E�xi3 606a/
ra 13125 SW Hall Blvd,Tigard,OR 97223 O C T
C Plan Review Other Permit
Phone. 503.718 2439 Fax: 503.598.1960 Date/By
I'f E; R U Inspection Line- 503 639.4175 Or q Date Ready/By Suns El See Page 2 for
CITY"° �I '" � Notified/Method Supplemental Information
Internet: www tigard-or.gov i pp
O Ill nimn NA/Kill
' TYPE OF WORK PLAN REVIEW .
El New construction 'GI•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
►:II-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
El Emergency system larger separately derived system
❑Addition of new motor load of ❑"A","E","1-2","l-3",
Job no.: Job site address: (24.-,,2_1 5u3 i31:3-0:3 PL 100HP or more Recreational vehicle parks
City/State/ZIP:; �{ O r1 1'Z Z� ❑Health-care a Hazardous cations ❑Supply voltage for more than
t�� "1 1 ❑Hazardous locauons 600 volts nominal.
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more,
FEE'SCHEDULE
Cross street/directions to job site: We`r\ A V Description I Qty. I Fee. I Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
_ .Subdivision:— Lot no.: - 11,000 sq R or Less _-_ 168.54 ___4_ ___
\ \� � i3v\� MI.
Ea add'I 500 sq R.or portion 33 92 1
Tax map/parcel no.:
Limited energy,residential 75 00 2
DESCRIPTION OF WORK (with above sq ft)
Limited energy,multi-family 75 00 2
Wcktr\ Cn `i c - _ } ,-r n 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
, ^N Co 201 amps to 400 amps 133 56 2
Name: \nw� 1v -G' .eCkL 401 amps to 600 amps 200 34 2
Address: `_2:1 Cam•} 1 `l—`� p L 601 amps to 1,000 amps 301 04 2
Over amps volts 552 26 2
City/State/ZIP.�, c O C1'1 2 L Tem pora ry services or feeders installation,
alteration,and/or
Phone:((0 k9-) St L1 ,23a1 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, le-se, e ,/or ex- ang a ording o ORS 447,449,670,and 701. 401 amps to 599 amps 168 54 2
Owner signature: Date: I�' 2 I - i� 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
Contact name: A service or feeder fee,first i 56 18 56./( 2
branch circuit
Address: SC Each add'I branch circuit I 7 42 1 7.el 2.. 2
City/State/ZIP: 1 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: 0600 f/Z 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(1 hr min) 66 25/hr
City/State/ZIP:
Investigation(1 hr min) 66 25/hr
Phone:( ) Fax:( ) Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90 00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(%z hr mm)
' ELECTRICAL'PERMIT•.FEES '
Suprv. Electrician signature,required: Subtotal. if;if;•6/0
Print name: Date: Plan review(25%of permit fee)
State surcharge(12%of permit fee) 7-CD 3
Authorized signature: TOTAL PERMIT FEE —2 i• , -5
Print name: Date: This permit application expires if a permit is not obtained within I80
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 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 Ol to 25 kva zoo 34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25 Ol 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
OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning
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:
111 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(%,hr mm)
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
I\Building\Permits\ELC_PermitApp_ELR_ERE doc Rev 05/21/2013