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Permit yr II CITY OF TIGARD ELECTRICAL PERMIT 11111 a COMMUNITY DEVELOPMENT Permit#: ELC2015 00477 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/18/2015 Parcel: 2S103BA00109 Jurisdiction: Tigard Site address: 11590 SW ANN ST Project: BANKS Subdivision: LERON HEIGHTS Lot: 9 Project Description: Panel replacement and(2)branch circuits for garage outlets. Contractor: NORTH LAKE CONTRACTORS Owner: BANKS, RICHARD L 12900 NW LOVEJOY CT MENDEZ, ELIZABETH PORTLAND, OR 97229 10721 SE MCCREARY LN BORING, OR 97009 PHONE: 503-709-0985 PHONE: FAX: 503-641-3168 FEES Quantity Description Date Amount 1 ea Services or Feeders-200 06/18/2015 $100.70 Specifics: amps or less 2 crt Branch Circuits w/Purchase 06/18/2015 $14.84 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 06/18/2015 $13.86 Electrical Type of Const: Occupancy Grp: Total $129.40 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in ac • -- ..th approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. AT TION: Oregon la, eqU es you to follow the rules adopted by the Oregon Utility Notificati Center. Those r -s are set forth in OAR 952-00 1010 through OAR 9 101-0090. may obtain a copy of the rules or direct questions to OUNC by calling 50 •.1':7 r 1.800.332.- 44 Is.ued By: / �� ! i Permittee Signature: • .�r �• OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE Date: CONTRACTQ$INSTALLATION ONLY ,_ SIGNATURE OF SUPR.ELEC' Date: /`�/ LICENSE NO. O 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 USE ONI.1 City of Tigard Received •J f g �N Date/B : ' ;, 11 13125 SW Hall Blvd.,Tigard,OR 97� Plan Review 1 g Phone: 503.718.2439 Fax: 503.598. i�)fprCt ` Date/B : Related Permit 5: Inspection Line: 503.639.4175 �Q1J Ready Date By: ® See Page 2 for 1 Ili A R I Internet: www.tigard-or.gov 1 Notified Method: Supplemental Information TYPE OF WORK 1 PLAN REVIEW ❑New construction Addition/alteration/r ieerh t ♦1,S Please check all that apply(submit 2,sets of plans w/items checked): {i 1 i���l ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTR,U,CTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. I and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14.000 0 Commercial-use agricultural amps for all other installations. buildings. ❑ Multi-family ❑ Master builder 0 Other: ❑Fire pump. ❑Installation of150KVAor JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: I Job site address: ,I S9Q S W 4,4A) --/- 100HP or more. ❑"A"."E","l-2" "I-3" ❑Six or more residential units. occupancy. City/State/ZIP: 7r,QP-8 J 02 ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: I Project name: Uk ( ❑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 Qt.. 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'l 500 sq.ft.or portion 33.92 I ,t DESCRIPTION OF WORK Limited energy,residential 75.00 2 i 2$Arne PANcrL ©_ LA- /ti9-1( 1 Z Ct CO-,- (wehabovesm multi-family )J Z �' Limited energy,multi-family GAPA-Ca6- OU-TteVS 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: R 1-&("A (5 10 200 amps or less 1 100.70 1c170 2 �d 7d l Gres 201 amps to 400 amps • 133.56 2 Address: M� S f L 401 amps to 600 amps 200.34 2 City/State/ZIP: Q_ l d C-� N 601 amps to 1,000 amps 301.04 2 Phone:( ) .W 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 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,per panel A.Fee for branch circuits with Business name: above service or feeder fee, each branch circuit 42 !I-, ,- Contact name: B.Fee for branch circuits without Address: service or feeder fee,first 56.18 - branch circuit City/State/ZIP: Each add'I branch circuit • 7.42 _ Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 Email: _ Reconnect only 67.84 -- - CONTRACTOR Pump or irrigation circle 67.84 _ Business name: NOa-77.4 LR eo,/7-0.A.��w5 I ti, Sign or outline lighting 67.84 Z9 N f I1bY Signal circuit(s)er o or limited-energy ❑ Page 2 Address: (,t) panel,alteration,or extension. City/State/ZIP: Pop:174.NA 0�- 97 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(So2) 7Og-0985 Fax:( ) investigation(1 hr min) 90.00/hr Industrial plant(1 hr min) 78.18/hr t� Email: al Cevq.a12-e-S5 e fr‘a.11,cots, Inspections for which no fee is 'I N CCB Lie.: /S"C-/is Electrical Lie.: C 13 Suprv.Lic.: 4(.S specifically listed i'i hr min) 90.00/hr �� ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: 5,5�/ Print name: G W j I t S Date: (0-18,-(s- ,-1_( Required permit �I J 0 Review R hired(25%of elmit fee): State surcharge(12%of permit fee): ,'Jg,i6 Authorized signature: TOTAL PERMIT FEE: / 9a y This permit application expires if a permit is not obtained within 180 Print name: I Date: I days after it has been accepted as complete. * Number of inspections allowed per pennit. 1:1Buitding,PermitsELC_PcnnitApp_ELR_ERE.doc Rev 06/17/2015 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 Qh. I Each I Total Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 5.01 to 15 kva 133.56 _ I Audio and Stereo Systems* 15.01 to 25 kva 200.34 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) n Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 n 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 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(!!hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Subtotal(Enter on Page I): 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 ❑ Boiler Controls Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC n Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* Medical I I Nurse Calls I I 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.doc Rev 06/17,2015