Permit CITY OF TIGARD ELECTRICAL PERMIT
1111 a , COMMUNITY DEVELOPMENT Permit#: ELC2014-00526
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/15/2014
Parcel: 2S 102C 607600
Jurisdiction: Tigard
Site address: 13155 SW GRANT AVE
Project: Mortensen Subdivision: 2002-086 PARTITION PLAT Lot: 1
Project Description: Repair/replace bent mast from tree strike
Contractor: DICKINSONS ELECTRIC Owner: MORTENSEN, TIM&SHANNON
8449 SW BARBUR BLVD 13155 SW GRANT AVE
PORTLAND, OR 97217 TIGARD,OR 97223
PHONE: 503-246-3550 PHONE:
FAX: 503-213-6049
FEES
Quantity Description Date Amount
1 ea Reconnect Only 09/15/2014 $67.84
Specifics: 1 ea 12%State Surcharge- 09/15/2014 $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 a - ante ' • 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. ATT- TION: Oregon 'w r-• ' =s you to follow the rules adopted by the Oregon Utility Notification Center. • rules are set forth in OAR
952-001-:010 through OAR 952-1 -0090..•u may obtain a copy of the rules or direct questions to OUNC by calling 50 .232. !• or 1.800 4.•
Issu•dBy: ! _/� ', Permittee Signature:
/
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:
NTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' / � Date:
LICENSE NO. l()C9
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 1 I Applicati I t I I I( I I `I ()\I
City of Tigard OR Received / permit#:
III
• 13125 SW Hall Blvd.,Tigard,OR 9722 Plan Review
s Phone: 503.718.2439 Fax: 503.598.19 P 15 2014 Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Atria ® See Page 2 for
T I(i A R n Internet: www.tigard-or.gov CITY O- IG
I ..AK) Notified/Method: Supplemental Information
E OF shin IIEf11I( PLAN REVIEW _
❑New construction Addition/alteration/replacement
Please check all that apply(submit 2 sets of plans w/items checked):
❑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.
iTand 2-family dwelling 1:1 CommerciaUindustrial ID
building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: /3/ ' IOOHP or more. ❑"A","E","1-2°,"1-3^,
Ci /State/ZIP: s Six or more residential units. occupancy.
ty e ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty I Each I Total I "
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'1500 sq.ft.or portion 33.92 1
1174,a ) / DESCRIPTION OF WORK Limited energy,residential 75.00 2
1/1 _ t r � , (with above sq.ft.)
Pl1St—v31
t -6-1?-,.L., Limited nergy,multi-family 75.00 2
residential(with above sq.ft.) _
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps _ 301.04 2
Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale, lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
❑ APPLICANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension, er panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included) _
Phone:( ) I Fax: :( ) Each manufactured or modular 67.84 2
Email: dwelling,service and/or feeder
Reconnect only / 67.84 677$'f 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 0 /LC., r Sign or outline lighting 67.84 2
q 0 5 fie) /al 414,i--
Signal alteration,circuit(s)or extension. ❑ See Page 2 2
Address: panel,alteration or extension.
City/State/ZIP: 'fir / / Each additional inspection over allowable in any of the above
ty (�'�r i" 4 �Z- Additional inspection(l hr min) 66.25/hr
Phone: ' —' ' S! � i Fax:( 0' Y /3 3 C� ` Investigation(1 hr min) �� 66.25/hr
�' / Industrial plant(1 hr min) 78.18/hr
Email:
�/ _ __-, /i Inspections for which no fee is
CCB L�. �� `� Suprv.Lic +rtcally listed(Y hr min) 90.00/hr
��-5 ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: r Subtotal: (p7.��
❑Plan Review Required(25% permit fee): .----
Print name: Date: 9 ( P )�
State surcharge(12%of permit fee): �(.%Y
TOTAL PERMIT FEE: 9
Authorized signature: 7S'
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:\Building\Permits 1ELC_PemiitApp_ELR_ERE.docx Rev 04/21/2014 440-46151(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
Description I Qty. I Each I Total I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over25 7.42 3
I=1 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 66.25/hr 1
charged at an hourly(1 hr min) - __
Inspections for which no fee is 90.00/hr
specifically listed(%:hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONLY: Subtotal(Enter on Page l):
Fee for each commercial system: $75.00 • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
H Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
H Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
n 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.docx Rev 04/21/2014