Permit n CITY OF TIGARD ; ELECTRICAL PERMIT
11 1 a - •
� COMMUNITY DEVELOPMENT Permit #: ELC2012 -00229
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439
D ate Issued: 04/20/2012
,.• Parcel: 2S103DA05500
Jurisdiction: Tigard
Site address: 13465 SW 107TH AVE
Project: HURLEY Subdivision: FANTASY HILL Lot: 6
Project Description: (1) sup panel and (3) branch circuits for accessory structure 6/24/13, reprinted to add (1) additional branch circuit.
Contractor: OWNER Owner: HURLEY, DENNIS & DANA
13465 SW 107TH AVE
TIGARD, OR 97223
PHONE: PHONE. 503 - 968 -6659
FAX'
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 04/20/2012 $100 70
Specifics: amps or less
3 crt Branch Circuits w /Purchase 04/20/2012 $22 26
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 04/20/2012 $14 76
Electrical
Type of Const: 1 crt Branch Circuits w /Purchase 06/24/2013 $7.42
Occupancy Grp: Service or Feeder
0 ea 12% State Surcharge - 06/24/2013 $0.89
Electrical
Total $146 03
Required Items and Reports (Conditions)
This permit is issued sub' • a regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law All work will
be done in accord- • •- with approve= 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. ATTENT o . Oregon law requ ou to follow the rules adopted by the Oregon Utility N • ■ - - = ter. Those rules are set forth in OAR
952-001-0011 rou• . OAR 952- 001 -0092 You m- • • . in a copy of the rules or direct questions to OUNC by "" or 1 800 332.2344
Issued :y: „-. i L / �4 j Permittee Signa _ 4 ( ',r
f 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.
CITY OF TIGARD ELECTRICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: ELC2012 -00229
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/20/2012
Parcel: 2S103DA05500
Jurisdiction: Tigard
Site address: 13465 SW 107TH AVE
Project: HURLEY Subdivision: FANTASY HILL Lot: 6
Project Description: (1) sup panel and (3) branch circuits for accessory structure.
Contractor: OWNER Owner: HURLEY, DENNIS & DANA
13465 SW 107TH AVE
TIGARD, OR 97223
•
PHONE:
PHONE: 503 - 968 -6659
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 04/20/2012 $100.70
Specifics: amps or less
3 crt Branch Circuits w /Purchase 04 /20/2012 $22.26
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 04/20/2012 $14.76
Electrical
Type of Const:
Occupancy Grp:
Total $137.72
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 fo more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules ar. �t forth in OAR
952- 001 -0010 through - 001 -0090. You may obtain a • • of the rules • a•;,;= t questions to OUNC by calling 503.232.1987 or 1.8 •
Issued By: _ _ Permittee Signature: ✓_ /Li_
are)
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 USE ONLY
City Tigard OC / of Ti and . `
Received /
f � � i : . /L4
11 . 13125 SW Hall Blvd., Tigard, OR 97223 ^01� - " -
Date/B : Plan Review Permit No. -
q 1. - Other Pennit:
-
Phone: 503.718.2439 Fax: 503.598.1960 o / 0 - Date/B :
TI G A R D Inspection Line: 503.639.4175 ` il Date Ready /By: • Juris: 65 See Page 2 for
Internet: www.tigard- or.gov 'fkkir '- Y l'''fied/Method: p Supplemental Information
F \ S
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TYPE OF WORK C - � . 't( � ,�(�} PLAN REVIEW
El New construction ®A ddition/alteration/r�l fnent • 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.
El D emolition ❑ 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
- 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 "1 -3 ",
Job no.: Job site address: 13465 SW 107th Ave 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, Or ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Detach age Addition ,fie ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Westward on Park St. off 99W to 107th Av Description . I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
proceede one block to the end. Site is on the right. Includes attached garage.
Subdivision: N/A Lot no.: 5500 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: 2S13DA - 05500 Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
Put back existing electrical as it was using new components as necessary residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100.70 /61.7e 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Dennis and Dana Hurley 601 amps to 1,000 amps 301.04 2
Address: 13465 SW 107 Ave Over 1,000 amps or volts 552.26 2
City/ State/ZIP: 97223 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)968 -6659 Fax: ( ) 200 amps or less 59.36 l
201 amps to 400 amps 125.08 2
Owner installation: This installation is be g made on property that 1 own which is not
401 amps to 599 amps 168.54 2 •
intended for sale, lease, re t e acco ing to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner Signature Date: ) ^Z0' s A. Fee for branch circuits with
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 3 7 42 a6 2
each branch circuit
Business name:
B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Dennis Hurley branch circuit
Each add'l branch circuit 7.42 2
Address: 13465 SW 107th Ave Miscellaneous (service or feeder not included)
City/State/ZIP: Tigard, Or. 97223 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 968 - 6659 Fax: : ( ) • Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: dndhurley @frontier.com Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name:
panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (I hr min) 66.25/ hr
City/ State/ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (' /: hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Subtotal: / - 9 Co
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): I pi. 7 (p
TOTAL PERMIT FEE: ' 371 7,L
Authorized signature:
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 \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(I1 /05 /COM/WEB
1.,,
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.055 (4))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
. — ■ki / S H 1Z 1.c4
Print Name of Permit Applicant
// _
) 7
dew-- of Perm' Applicant Date
Permit #: L Old 1a 2 —C)n 3
Address: A
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7id d rile q -24-3 h
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Issued by: 0 •) ' Date: �17�DA t i=
This Copy for Permit Offices
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
13465 SW 107TH AVE, TIGARD, OR, 97223
Residential - Electrical
115 Electrical service
06/25/2013 00:00
ELC2012-00229
PASS
Tamper resistant recepts at final
Breaker hold down on main breaker
Isolate neutrals and grounds
Gfi tamper resistant protection
Violation Summary:
Inspector Contractor