Permit rt CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2014-00021
Date Issued: 01/15/2014
TIGARD 13125 SW Hall Blvd..Tigard OR 97223 503.718.2439 parcel: 2S102CD02706
Jurisdiction: Tigard
Site address: 9695 SW OMARA ST
Project: Worley Subdivision: FREWING'S ORCHARD TRACTS Lot: 27
Project Description: Regrounding due to replacement of water service
Contractor: OWNER Owner: WORLEY. MARTHA W
9695 SW O'MARA
TIGARD, OR 97223
PHONE: PHONE: 503-639-6563
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 01/15/2014 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/15/2014 $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 acc. •. ,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 A ' ION- Oregon la.* r ires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952-00 x010 thro h OAR 952-00 090. ou may obtain a copy of the rules or direct questions to OUNC by calling 503 2. 987 or 1. 00 332.2344
r y/J"`/
Issued By: Permittee Signature: Y.'
� / /L
OWNER INSTALLATION ONLY
The installation is being made on props I own w ' h is not intended for sale,lease or rent /
OWNER'S SIGNATURE /, 4 L Date: / 717//Y
OF
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 bo 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 �,y� 1
City of Tigard Received j i5' 4' A. i Permit No.:�'t:.e,Ao/S--two(/
r 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
: I Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: )uric: - 0 See Page 2 for
I I t■-1 I:I t Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ❑Addition/alteration/replacement Please check all that apply(submit j 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 El Commercial/industrial ❑Accessory building amps for all other installations buildings.
❑Multi-family ❑Master builder El Other: ❑Fire pump. ❑Installation of 150 KVA or
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A","E","1-2","I-3",
Job no.: Job site address: Q 14' to tJ/f'I A - 100HP or more occupancy.
' ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: 7—; 6,47e X g`7 - 3 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: ,--I Project name: ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Pee. 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'1 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 75.00 2
l ,vL, U residential(with above sq.ft.)
Renewable Energy _ ❑ See Page 2
u Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: /1/ .11 TAX (,f)c -& ' 401 amps to 600 amps 200.34 2
Address: ,c– ' D /-7/9X-If S 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: --/---; _,15€4, 0 ..c.-. 9 7 .g.- e.3 Temporary services or feeders installation,alteration,and/or
Phone:(S ) L',, - 7' 3 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,��re�n�t,�,or�f,exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: �1 e t Date: /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: service or feeder fee,lust / 56.18 56.1 8 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: 1,0() //C./ 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(I hr min) 66.25/hr
Phone:( ) I Fax:( ) Industrial plant(1 hr min) 78.18/hr
•Inspections for which no fee is
CCB Lie,: I Electrical Lie.: Suprv.Lie.: specifically listed(Y:hr min) 90,00/hr
PERMIT FEES
ELECTRICAL
Electrician signature,required: L.
Subtotal: 6,1
Print name: Date:
Plan review(25%of permit fee): ---
,' / , p��� State surcharge(12%of permit fee): lD.7t{
Authorized signature:`.1 l)"-""�1" - TOTAL PERMIT FEE: (P 2%,gg.
(J 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.
1:1Buildina\Pennita\ELC_PermitApp_ELR ERE.doe Rev 05/21/2013 440.4615T(I1/05/COMIWEB
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 1 Qty- I Fee I Total I •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kvaorless 100.70 2
5.01 to 15 kva 133.56 2
n 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
n Heating,Ventilation and Air Conditioning
OAR 918-309-0040) 552.26 2
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
[IIOther: additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly(1 hr min) 6625/hr
Inspections for which no fee is 90.00/hr
specifically listed(%z 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 permit is not obtained within 180
nAudio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
❑ Boiler Controls
n Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
HVAC
n Instrumentation
n Intercom and Paging Systems
TI Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:1Building\Permits\ELC_PennitApp_ELR_tRE.doc Rev 05/21/2013
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