Permit CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT Permit#: ELC2014-00687
T1GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/02/2014
Parcel: 1 S134CCO2900
Jurisdiction: Tigard
Site address: 11945 SW 122ND CT
Project: Brouwer Subdivision: YE-OLDE WINDMILL Lot: 15
Project Description: (3)branch circuits for furnace and heat pump.
Contractor: ACCURATE ELECTRIC OF OREGON INC Owner: KRUGER FAMILY SURVIVORS TRUST
PO BOX 2155 2469 ROCKBROOK LN
OREGON CITY,OR 97045 MANTECA,CA 95336
PHONE: 503-631-3507 PHONE:
FAX: 503-631-3544
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 12/02/2014 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/02/2014 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
Required Items and Reports(Conditions)
This permi • subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be d• - in accordance '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
da -. ATTENTION: Oregon law re.u'res you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
9 2-001-0010 thro gh OAR 952-901 :990. •• may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800. 344.
-sued By: Permittee Signature: 1
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: /ig/a/j
LICENSE NO. JS ( '
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 ��,1� I OK (II I It I l SI. 11\I )•City of Tigard � ��� Received• Date/13 iy
illq ��to
13125 SW Hall Blvd.,Tigar 3 Plan Review r
■ Phone: 503.718.2439 Fax: 8.1960 Date/B : Related Permit 8:
Inspection Line: 503.639.4175 2 14 Ready Date/By: Surir. HI See Page 2 for
I I t';\I`I) Internet: www.tigard-or.gov V�- Notified/Method: c0 4,1 Supplemental Information
TYPE 01„ �,1b� PLAN REVIEW
❑New construction t0 AdditionANC Q�(( ��gC1� Please check all that apply(submit a sets of plans w/items checked):
e �\\v ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: , 1 where the available fault current
T A+� ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
e 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑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
Job#: Job site address: C w L Z►^d ❑Addition of new motor load of system.
1 /.S 5 I �.T I00HP or more. ❑"A","E","I-2","1-3",
CiCity/State/ZIP: I 2 ❑Six or more residential units. occupancy.
ty 1 1,LI..tA t(Tfl 9 7 2 3 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Bra J lei- ❑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 1 Qty. 1 Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: Lot 4: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
cif )•e..4 p jwith above sq.ft.) 75.00 2
C0 f\1•41cl r -.v- �2rx�e otw olo Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
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:( ) 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 I I
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 la CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: / c ,rc E(e cti-rtc. of 0 above service or feeder fee, 4 2
each branch circuit _ _
Contact name: iejs..y\ St/-,c-kr B.Fee for branch circuits without
service or feeder fee,first i 56.18 30./g 2
Address: pc. 8.11t a.l SS branch circuit
City/State/ZIP: 0 61t 9i0`!S Each add'l branch circuit Z 7.42 /' pi 2
t Miscellaneous(service or feeder not included)
Phone:(5-0j) b 3 1 - 3 so-7 Fax: :(sO1 ) 63) - 39 yy Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: &c„,„,-*„..., ;!',c t t, 0-f- 0 Signor outline lighting 67.84 . 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: ()o Q&,... 1 c5 g
panel,alteration,or extension. _
(1,/�{ ^� `� Each additional inspection over allowable in any of the above
City/State/ZIP: 0
r "' r i 1 / 5 Additional inspection(1 hr min) 66.25/hr
Phone:(>o ) 63 I — 350`7 Fax:($tJ) ) 631 — 3 541 l; Investigation(I hr min) 66.25/hr .
Email: 1 oi( 341,7 7444 7/1 117 !O'1 I II/ Industrial plant(l hr min) 78.18/hr _
Inspections for which no fee is 90.00/hr
CCB Lic.: a '7 Electrical Lic.: •(p 3 Suprv. Lic.: 501'15 specifically listed CA hr min) ,
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: " Subtotal: 7l C
Print name: 1<e vs. So./c-O Date: 1Z-2 - 1`! ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): ij, > 2-
Authorized signature: f l — TOTAL PERMIT FEE: 7 Q. 5(/
This permit application expires if a permit is not obtained within 180
Print name: i/� S,N�z- Date:( ?-2- /te/ days after it has been accepted as complete.
!` Number of inspections allowed per permit.
L\Building\Permits\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014 440-46151(1I/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 Qtr. 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
❑ 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(%Z hr min)
COMMERCIAL WORK ONLY' ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal l( permitn Page 1):
y * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ 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
1:\Building\Permits\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014