Permit it p CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2015-00551
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/16/2015
Parcel: 2S 102C 002000
Jurisdiction: Tigard
Site address: 9680 SW OMARA ST
Project: COLLETT Subdivision: EDGEWOOD Lot: 20
Project Description: (1)branch circuit for heat pump installation.
Contractor: OWNER Owner: COLLETT, REBECCA M
REBECCA COLLETT 9680 SW O'MARA ST
9680 SW OMARA ST TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-481-3260 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 07/16/2015 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 07/16/2015 $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 applicable 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 is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. • ose rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You py of hefulrsor direct questions to OUNC by . • r •.1987 0 '.0.332.2344.
Issued By: Permittee Signal AO, _it_
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 RECEIVE / FOR OFFICE USE ONLY
City of Tigard Date/B ! . Permit++:
" 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie , ,3TT E LC�15 _I.X)S-`/
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit 5:
T 1 C;A R I Inspection Line: 503.639.4175 JUL 16 2015 Ready Date/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: � Supplemental Information
TIRE OF WOR . s s �/' , PLAN REVIEW
❑New construction ddition/altera WarDI Please check all that apply(submit a 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.
d 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14.000 ❑Commercial-use agricultural
an
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:'-/�Fb Sw (� i� '7 ❑I OOHioo of new motor load of system.
IOOHP or more. ❑°A""E" "I-2" "1-3'>
City/State/ZIP: ✓ ❑Six or more residential units. occupancy.
l/j 0 ir'd 0 2 %7213 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: tl Project name: eolith,Iza:fieklis, ❑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 tit■. I Each I Total I *
New residential single-or multi-famil■ 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 1
DESCRIPTION OF WORK Limited energy,residential
- (with above sq.ft.) 75.00 '_
C=/C :7� 7X !7•e.r-1 Div-/ i/v,th1 1-7- Limited energy,multi-family ,
' / residential(with above sq.ft.) 75.00
5r '6•1 C,/./.
r✓' E4- Renewable Energy ❑ See Page 2
❑_ ROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: /abeaw (f-3l/e Tr 200 amps or less 100.70 2
Address: 9',�0 Si c) /1�G S� 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZiP a 6/ q 72 13 601 amps to 1,000 amps 301.04 _ 2
Phone: (/ '. 3 c V I Fax:( ) Over 1,000 amps or volts 552.26 2
/t'+ 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 e,lease,r ,o ch ding to ORS 447,449,670,and 701. 0"201 amps to 400 amps 125.08 _
Owner sigma I Date: 7/&// C 401 amps to 599 amps 168.54 _
❑ APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: e // � � above service or feeder fee. 7.42•V+ ` 2 3 n iLd each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first / 56.18 �,f Y 2
branch circuit
City/State/ZiP: Each addl branch circuit 7.42 _
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular 67.84
Email: dwelling,service and/or feeder
q � Reconnect only 67.84
. 1.111L.,-• CONTRACTOR Pump or irrigation circle 67.84 _
Business name: ��f Sign or outline lighting 67.84
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: panel,alteration,or extension. g
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) I Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.: I Electrical Lie.: I Suprv.Lic.: specifically listed('V hr min) 90.00/hr
ELECTRICAL PERMIT FEES _
Suprv. Electrician signature,required: Subtotal: ,s--T. [f
Print name: I Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 4.. '711
TOTAL PERMIT FEE: la
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: I Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
I:'Building'Permits'ELC_PermnApp_ELR_ERE.doc Rev 06/17/2015 440-46151111/05/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 Qts. I Each I Total i
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
I Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
F7 Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
n Other: Each additional inspection is
1 I 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
spcciticall} listed 1'_hr mint
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Entet on Page I):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
Boiler Controls
n Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
I Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:•Building\Permits\ELC_PermiApp ELR ERE.doc Res 06 17 2015