Permit CITY OF TIGARD ELECTRICAL PERMIT
13 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00128
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/07/2012
Parcel: 2S 111 CC08400
Jurisdiction: Tigard
Site address: 15755 SW GREENS WAY
Project: KEMMERER Subdivision: SUMMERFIELD NO.2 Lot: 111
Project Description: Remodel.
Contractor: VANGUARD ELECTRIC INC. Owner: KEMMERER, ROBERT L REVOCABLE TRU
3800 MORRIS ST KEMMERER, ZOE A REVOCABLE TRUST
NEWBERG, OR 97132 15755 SW GREENS WAY
TIGARD, OR 97224
PHONE: 503 - 537 -5006 PHONE:
FAX: 503 - 537 -5019
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo /Purchase 03/07/2012 $85.86
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/07/2012 $10.30
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
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. Those rules are set forth in OAR
952 -001 -0010 through OAR • 52- 001 -0090. You ma obtain a co. • = ule - :• •uestions to OUNC by calling 503.232.1987 1.800.332 44.
Issued By ! � •-••••■••l 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:
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 rc)R UrrICF. USE ONLY
Received
11
City of Tigard , pie
• Date/By: J 7 0.. 0.. err
Permit No.: I,2 - UU
13125 SW Hall Blvd., Tigard, OR 9722 011 ^ Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
Inspection Line: 503.639.4175 MP Cam'- Date Ready/By: kris: ® See Page 2 for
TIGARD t►>
Internet: www.tigard- or.gov O c � 1cotifie d/Method: � Supplemental Information
ill TYPE OF WORKC ` �11 7 PLAN REVIEW
❑ New construction , addition /alteratiorra l► ac + e ' ment Please check all that apply (submit 2 sets of plans w /items checked below):
❑ 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.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
4- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "I - ",
Job no.: 1 Job site IOOHP or more. occupancy.
15755 4 � E£ N� l td ON 0 Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ZSc ( , D ,z23,3 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: �t''ll L
,,( p A , t � A ❑ Service or feeder 600 amps or more.
Y l
FEE SCHEDULE
Cross street/directions to job site: Description I Qtv. I Fee. I 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
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 I
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, muhi- family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: &<civx / •° fir-, P-O'P�t 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
ty relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first l 56.18 it 2
Contact name: branch circuit
Each add'I branch circuit S{ 7.42 99,4e 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
tY dwelling, service and/or feeder
Phone: ( )
Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
` ' M- /1/ panel, alteration, or extension. Page 2 2
Business name:
Aa 1.6.49 . �c.c. C. Each additional inspection over allowable in any of the above
/
Address: , 'p_ 5 5 s Additional inspection (1 hr min) 66.25/ hr
* � ` 1 p� Z_ Investigation (1 hr min) 66.25/ hr
City /State /ZIP:
`V K.y (J�� 7ey Industrial plant (I hr min) 78.18/ hr
Phone: (3) S 37► /` / l iFax� - ) _ : Inspections for which no fee is 90.00 / hr
h specifically listed (% hr min)
CCB Lic.: /6 it 5 Lic.: 36 t /O C. Suprv. Lic.: 4 ELECTRICAL PERMIT FEES
,,- / e _ • 0(L Subtotal: �i
" . . r -
Suprv. Electrician si / t�tquire /�
�' ���
Plan review (25% of permit fee):
Print name: _ _ D. - • 3 /2-- State surcharge (12% of permit fee): () 30
TOTAL PERMIT FEE:
Authorized signature: This permit application expires if a permit is not obtained wt • i 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
1: \ Building \Permits\ELC- PermitApp.doc 07/01 /10 440- 4615T(II /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
❑ Burglar Alarm
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00 •
system '
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
• ❑ Other
Total number of commercial systems:
. *No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 07/01/10
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15755 SW GREENS WAY, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
05/01/2013 00:00
ELC2012-00128
FAIL
1. Open ground on downstairs bathroom gfi
2. All Gfci recepts to be tamper resistant 406.4D(3)
3. Recept to right of refer needs gfi protection 406,4D(3)
4. Upstairs bathroom recepts to be Gfci protected 406.4D(3)
5. Upstairs bath fan to be on a timer per ORSC M1507.4
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15755 SW GREENS WAY, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
05/01/2013 00:00
ELC2012-00128
FAIL
1. Open ground on downstairs bathroom gfi
2. All Gfci recepts to be tamper resistant 406.4D(3)
3. Recept to right of refer needs gfi protection 406,4D(3)
4. Upstairs bathroom recepts to be Gfci protected 406.4D(3)
5. Upstairs bath fan to be on a timer per ORSC M1507.4
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15755 SW GREENS WAY, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
05/01/2013 00:00
ELC2012-00128
FAIL
1. Open ground on downstairs bathroom gfi
2. All Gfci recepts to be tamper resistant 406.4D(3)
3. Recept to right of refer needs gfi protection 406,4D(3)
4. Upstairs bathroom recepts to be Gfci protected 406.4D(3)
5. Upstairs bath fan to be on a timer per ORSC M1507.4
Violation Summary:
Inspector Contractor