Permit n CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00499
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/23/2012
Parcel: 2S102CA00222
Jurisdiction: Tigard
Site address: 13115 SW ASH DR
Project: Thomas Subdivision: VIEWCREST TERRACE Lot: 20
Project Description: (1) 200 amp service and (18) branch circuits to replace all residential electrical wiring
Contractor: OWNER Owner: THOMAS, ANDREW J
WORKMAN, MELISSA A
13115 SW ASH DR
TIGARD, OR 97223
PHONE:
PHONE: 503 - 453 -0507
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 08/23/2012 $100.70
Specifics: amps or less
18 crt Branch Circuits w /Purchase 08/23/2012 $133.56
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 08/23/2012 $28.11
Electrical
Type of Const:
Occupancy Grp:
Total $262.37
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 95 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 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: g/ Z 3 //
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
• COMMUNITY DEVELOPMENT Permit #: ELC2012 -00499
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/23/2012
Parcel: 2S102CA00222
Jurisdiction: Tigard
Site address: 13115 SW ASH DR
•
Project: Thomas Subdivision: VIEWCREST TERRACE Lot: 20
Project Description: (1) 200 amp service and (18) branch circuits to replace all residential electrical wiring. 9/6/12, adding (11) branch
circuits.
Contractor: OWNER Owner: THOMAS, ANDREW J
WORKMAN, MELISSA A
13115 SW ASH DR
TIGARD, OR 97223
PHONE PHONE: 503 - 453 -0507
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 08/23/2012 $100.70
Specifics: amps or less
18 crt Branch Circuits w /Purchase 08/23/2012 $133.56
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 08/23/2012 $28.11
Electrical
Type of Const: 11 crt Branch Circuits w /Purchase 09/06/2012 $81.62
Occupancy Grp: Service or Feeder
0 ea 12% State Surcharge - 09/06/2012 $9.80
Electrical
Total $353.79
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 R 952- 001 -0090. You may obtain copy of the rules or direct questions to OUNC by calling 503.2 or 1.800.332.2344.
Issued By: 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 4J Ct -1-.4, Date: VO Z
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.
RECEIVE)
Electrical Permit Application FOR oFFrcl• USE ONLY
AUG 2 3 ?t112 . Da a B �j[L � � D0 99
City of Tigard Re e ive �.�� .Z �/J� Permit No. aQ�� _ y
° 13125 SW Hall Blvd., Tigard, OR 97223 P Revie
Ill TrY OF TIGARD Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 C ate/By:
Inspection Line: 503.639.4175 BUILDING DNISIO Date Ready/By: Juris: ® See Page 2 for
T I G A R D N otified/Method: Supplemental Information
Internet: www.tigard-or.gov T��.� pp
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
El New construction �ddition/alteration/replacement
❑ 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
I9 1 and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: , 0 Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
S W 1 ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: I � s 3 -- Q(� 3 ❑ Six 4 6 , Six or more. Recreational
ix o or r more re residential units. ❑ r vehicle parks.
Clty/State /ZIP: Q ❑ Health -care facilities. ❑ Supply voltage for more than
T► J q Ot / d l 7 Z Z 3 Hazardous locations. 600 volts nominal.
j� _ "� O p aster ❑ Service or feeder 600 amps or more.
Suite/bldg. /apt. no.: Project name: I Iw r
FEE SCHEDULE
Cross street/directions to job site: Sw 4, P r f Sw 4,1, Ave
Description I Qtv. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
C P1 eat .r SC") Ni II Includes attached garage.
Subdivision: . Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
V e-rif q ('o. . di 1 q no 1 of e fgi/i C to cal Pte` /14 n u1 residential (with above s ft.)
V\ ` / J/ Services or feeders installation, alteration, and/or relocation
R eplACe / .• -t. Ain se.rIIrce rote' pe-p(ace a►lK�tt)lttN( 200 amps or less ` 100.70 /06, 2
I3� PROPERTY OWNER ❑ TENANT 1,4' q. 201 amps to 400 amps 133.56 2
Name: R Yl � e �,� T J
401 amps to 1, 0 amps amps 30.04 2
� M'L4S 601 amps to 1,000 amps 3011.04 2
Address: (3 1 15 $ (-J • ! 3 I b Over 1,000 amps or volts 552.26 2
Ci City/State/ZIP: �---� Temporary services or feeders installation, alteration, and/or
n 1 1 et.r•d /01Q 7 4 7 Z z 3 relocation
Phone: (543 ) S q — 05 -7 Fax: ( ) 200 amps or less 59.36 I
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, accord' to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: 8/ Z 3 h Z A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, ( 8 7 42 /33. -542 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 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
Business name: 0 � N L panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: Industrial plant (I hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed (V2 hr min) 90.00 / hr
CCB Lie.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Subtotal: '
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): , ef, i/
TOTAL PERMIT FEE: Z .2, 3 7
Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit. 7 t ? t)
s .
I:\Building\Permits\ELC- PermitApp.doc 07/01/10 4404615T(11/05/COM/WEB 2 y.. -5- 7
Electrical Permit Application ' tY g c VE FOR OFFICE USE ONLY
G
City of TI and R eceived PermitNo.: .LG Z Z — YM`
Date/By: qQ
° 13125 SW Hall Blvd., Tigard,OR 97223 0 6' iolz Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 SEP Date/By: Other Permit:
TI G A K D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard or.gov C "e M Of TI R D Notified/Method: Supplemental Information
TYPE OF WO �1O G " y PLAN REVIEW
❑ New construction Addition /alteration /replacement 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
(and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: 0 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 ", "I -3 ",
Job no.: E( 1 L-201Z'V} I e address: 13 05• 0 4s h D P Six or more occupancy.
5 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: -( �i 7og tt Z �3 7 ❑ Health -care facilities. ❑ Supply voltage for more than
1 ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. 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
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
(ier.. -1 Aline. t e L 3 ' re - residential (with above sq. ft.) 75.00 2
f Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
[D4ROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
A // 401 amps to 600 amps 200.34 2
Name: A r qj 601 amps to 1,000 amps 301.04 2
Address: 13 (i S� A 5'h .6 /t Over 1,000 amps or volts 552.26 2
City/State /ZIP: l / dR / 9 7 / Z Z 3 Temporary services or feeders installation, alteration, and /or
print relocation
Phone: ( 3 ) z 0 5' '7 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
intended for sale, lease, rent, or exc ge, ac RS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
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 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
h 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
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 (V2 hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: o Subtotal:
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee):
TOTAL PERMIT FEE:
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.
Num o inspections allowed per permit. -
I:\ Building \Permits\ELC- PennitApp.doc 07/01/10 440- 4615T(11 /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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ 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:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: _
•
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermilApp.doc 07/01/10
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13115 SW ASH DR, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2012-00499
Herb Stabenow
Violation Summary:
Inspector Contractor