Permit lr u CITY OF TIGARD ELECTRICAL PERMIT
ig s ' COMMUNITY DEVELOPMENT Permit#: ELC2015-00057
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/02/2015
Parcel: 2S103BD00400
Jurisdiction: Tigard
Site address: 11850 SW WALNUT ST
Project: HANSEN Subdivision: 2007-085 PARTITION PLAT Lot: B
Project Description: (1)branch circuit for ground rods.
Contractor: METRO ELECTRIC INC Owner: HANSEN, EDITH A
3860 SE PELTON AVE 9894 RD 18 NE
TROUTDALE,OR 97060 MOSES LAKE,WA 98837
PHONE: 503-666-2154 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 02/02/2015 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 02/02/2015 $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 •pli able 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 ' -u •ended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. •• ,� r -s - e set forth in OAR
952-001-0010 through OAR 952-001-0090. You•• • -c••y of the rules• •irect questions to OUNC by calling 503.23.198•44.' g ./••
Issued By: / - •• LL I ■
■
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 1-SF.ONLY
City of Tigard Received(� Date/B : . ,. Permit No.: L.u _ ;7
• 13125 SW Hall Blvd.,Tigard,OR 97223 `1� Plan Review
I Phone: 503.718.2439 Fax: 503.598.1 Date/B : Other Permit T 1 G.A R Il Inspection Line: 503.639.4175 rYCON Date Ready/By: Supplemental See Page 2 Information
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK t.-‘)_ ��� i PLAN REVIEW
❑New construction Addition/alteration/r pl"aeement yy_�N Please check all that apply(submit 2 sets of plans w/items checked below):
(;XV" ❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑Other: , ��° �t11SI"� . where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTR 1 ed r ., Y exceeds 10,000 amps at ISO volts or ❑Floating buildings.
��ii lkI less to ground,or exceeds 14,000 ❑Commercial-use agricultural
inei-and 2-family dwelling ❑Commercial/industll 4 .' • 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 ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","1-2","I-3",
Job no.: Job site address: `` ., `\ I OOHP or more. occupancy.
��� 1 \ o 5LLJ i cr c- LCD ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: j t oLCrAt- ( !' '+ ❑Health-care facilities.
❑Hazardous locations. ❑Supply voltage for more than
600 volts nominal.
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more
441 SW FEE SCHEDULE
Cross street/directions to job site: Description I city. I Fee. ] 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 I
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
v r7 Limited energy,multi-family 75 00 2
TLC)`...ti.�{ � ,_x� residential(with above sq.ft.)
J Renewable Energy ❑ See Page 2
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: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) 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,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or ex_tension,per panel
❑ APPLICANT ❑ 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 �j
Contact name: service or feeder fee,first I 56.18 3 10 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
��
- � y _ Signal circuit(s)or limited energy See
Business name: '/CC' ,,,; panel,alteration,or extension. Page 2 2
Address: 3B6,0 IPA e Each additional inspection over allowable in any of the above
r-/� Additional inspection(1 hr min) 66.25/hr
City/State/ZIP ,. ,C q 70(00 Investigation(I hr mm) 66.25/hr
Phone:(503 )641(e a ,S Cf Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB I.ie.:A)leG,j Electrical Lic.:C • e. Suprv.Lic.: 5Z4 7 S specifically listed('/2 hr min)
�/ ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
/I r� Subtotal: 15
Print name: / i' Date: = '' Plan review(25%of permit fee):
�"t n�' r= l�ck(t.(t+ �C L 5 State surcharge(12%of permit fee): & :117
Authorized signature: ` TOTAL PERMIT FEE: 6). . 4.2
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.
I.\Building\Pennits\ELC_PermitApp_ELR_ERE doc Rev 05/21/2013 440-4615T(11/05/COMIWEB