Permit REVISED ELECTRICAL PERMIT
CITY OF TIGARD
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00224
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/17/2013
Parcel: 25111 CD08600
Jurisdiction: Tigard
• Site address: 15935 SW SERENA CT
Project: Hawk Subdivision: KERWOOD ESTATES Lot: 1
Project Description: (1) 200 amps or less to replace electrical panel 5/8/13 REPRINT to correct address
•
Contractor: FISHBACK ELECTRIC LLC. Owner: HAWK, THOMAS AND NIKKI
PO BOX 810 15935 SW SERENA CT
NORTH PLAINS, OR 97133 TIGARD, OR 97224
PHONE: 503 -430 -8800 PHONE:
FAX: 888- 700 -0130
FEES
Quantity Description Date Amount
• 1 ea Services or Feeders - 200 04/17/2013 $100.70
Specifics: amps or less
—
1 ea 12% State Surcharge - 04/17/2013 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
•
Total $112.78
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 OAA �2- 001-90. You may obtain a of the rules or direct questions to OUNC by calling 503.232.1987 or , 100.332.223 3VT 444.
Issued By: � I � 5 L4Z_f PermitteeSignature: P)k! APR) LI C I lU �
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
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00224
T (GA .R. D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/17/2013
Parcel: 25111 CD08100
Jurisdiction: Tigard
Site address: 15855 SW SERENA CT
Project: Hawk Subdivision: KERWOOD ESTATES Lot: 6
Project Description: (1) 200 amps or less to replace electrical panel
Contractor: FISHBACK ELECTRIC LLC. • Owner: HAWK, THOMAS AND NIKKI
PO BOX 810 15855 SW SERENA CT
NORTH PLAINS, OR 97133 TIGARD, OR 97224
PHONE: 503 -430 -8800 PHONE:
FAX: 888 - 700 -0130
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 04/17/2013 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 04/17/2013 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 OfyR 52 -001 090. 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: �'V(. Permittee Signature: 1'k ' `"r C4 I (( )
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.
Flom Loren Fishback Fax: +1 (888) 700-0130 To: Fax: +1 i503) 598-1960 Page 1 of 3 4/16/2013 12:06
Electrical Permit Application RECEIVED
City of Tigard , , -
Received ---
uatetiy: •7 f 5 S Perm
( it .e ,90t 0
13123 SW Hall Blvd.. 'lipid, OR 97223 A C4 f PR 16 2013
II Plan Review
' I Phone: 503.718.2439 Fax: 503.598.1960 Date,fly: Caber Pelmet:
T 1G .„, p n Inspection Line: 503.639.4 175 CITY OF TIGARD Dat Ann' lid See Page 2 far
Internet: www.tigard-or.gov Blrli DINnnly!tnNi Knurled/Method: rtec, Sup pknuneal Information
I 1 PE Of V. MK Print name: 1)iti
0 New construction E Addition/alteration/replacement
.....::;.,,,.....etAkilwyww.,....,....:10,.*:)':*=:?.:::
D Demol i I i on D Other:
Pr,:.,.,: .1 Cl; :Ili that apply (submit 2 sets of plant. wiitems ducked below).
CATEGORY OF CONSTRUCTION
EService or feeder 400 amps or more 0 nodding overdue@
— 0< 1- and 2-familv dwelling L.....: Commercial Accessor buildmg ,.\ 11Cre the ax addle fault currant sir/ries
exceeds a Mariam and boatyards.
El Multi-family E Master builder Other: 10,000 mps at ISO Yobs or 0
Iess to ground, or exceeds 14,000
JOB sac INFORMATION AND LOCATION amps for all other installations 0 Floating buildiegs.
Commercial-use
Job no.: Job site address: 15855 SW Serena Ct OFire pump a picultttriti
DEntergenCy *Stein. buikting,
City/State/ZIP: Tigard, OR 97224 DAddition of now motor kind of El Installation of 75 KVA
100HP or more. or
Suite/bldg./apt. no.: Project name: Hawk
Elsis or more residential units larger separately derived system.
Cross street/directions to job site: CI ilealth-care facilities. El
D Hazardous locations. Doocupancy.
Recreational vehicle
0 Service or feeder 600 park.s
Subdivision: I Lot no.: amps or more D Supply voltage for
Tax map/parcel no.: more than
6no volts nominal
DESCRIPTION OF WORK
Replace Electrical panel _ I 1 F. S( treDuLE
Wscriv t .11 Q0.. 1 Vet. TOW ^
New residential single- or multi-family dwelling unit.
Includes attached garage.
M PROPERTY OWNER 7 TENANT 1,000 so. ft. or loss 168.54 4
Name: Thomas and Nikki Hawk Ea. addl 518) so ft or portion 33.92 1
limited energy, residential
75 00 2
Address: 15855 SW Serena Ct (with above sq ft.)
Limited energy, multi-family
75310 2
City/State/ZIP: 'riprd, OR 97224 residential (with above sq. ft 1
Renewable Energy: Li See Page 2
Phone: ( ) Fax: ( ) Services or feeders installationoilterntion, andtor relocation
Owner installation: This installation is being made on properly that Iowa which is not 200 amps or less I 100.70 100.70 2
intended fur sale, lease, rent, or exchange, according to ORS 447, 449. 670, and 701. 201 amps to 400 amps 13336 2
Owner signature: Dale: 401 amps to 600 amps 200.34 5
/-
301.04 2
l'il A PPL.IC:AN 1' :.,';'l.,1l,.';',;.,l'll,E..''''llfill:;,;:,:lllatOitik61,iiigtigoli,i,,.:::!l;;:,ll:::4:::,. 6()1 an1 P""" 0 arE
: - ' ■ Over 1,000 amm or volts 557_26 2
Business nitrite: Fishback Electric I.Le Temporary services or feeders installation, alteration, and/or
relocation
Contact name: Alan Fishback 200 amps or less 59.36 I
Address: 201 amps to 400 amps 125.08 2 .
401 amps to 599 amps 168.54 2
City/State/Z1P: Branch circuits-- new, alteration, or extension, per panel
A Fee for branch circuits with
Phone: (503 ) R05 cell Fax: : ( ) above service or feeder fee,
7 42
E each branch circuit
2
B. Fee for branch circuits without
i ■771612 service or feeder fee, firm
56.18 2
Business name: Fish Electric I I I blanch circuit
Each add'I branch circuit 7.42 2
Address: PO ROX RIO Miscellaneous (service or feeder not included)
Each rnanolltetured or modular
67.84
t:ity/StalcIZIP df
: North Plaias, OR 97133 dwelling, service anor feeder 2
llixonnect only . . 1,7 84 2
Phone. (503) 430-8800 Fax: (888) 700-0130
2 ,1 1 tl Pump or irrigation circle , 67.84 2
CCII 1.k.: 147186 ,, . Electrical Lie.: 34-563C Suprv. tic.: 45615 Sign or outline lighting 67.84 2
-71,114 wil / 3 Signal circuits) or limited-energy
Sinirv. Flectrician signature, required: Panel. alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Print name: Alan hishhack Date: 4/16/2013 Additional inspection (1 hr min) 66251 hr
Investigation (1 hr min) 66.251hr
Authorized signature: ;1 0 E emeo... ler w
Industrial plant (1 hr min ■ 711.181 hr
T. \ B uildiniar rmi L s3ELC rani!. App_43409 I 3 dm: 440401 ST( II rn stcom/wEB I
From: Loren Fishback Fax: +1 (888) 700 -0130 To: Far: +1 (503) 598 -1960 Page 2 of 3 4/16/2013 12:06
Inspections I'or which no fee is I 90.00 / hr I
specifically listed 0/2 hr min)
ELECTRICAL PERMIT FEES
Subtotal: 100.70
Plan review (25% of permit fee):
State surcharge (12% of permit fee): 12.08
TOTAL PERM TT FEE: 112.78
This permit application expires if a permit is not obtained within 180 days after it has been accepted as
complete.
Number of inspections allowed per permit.
l: \building \Permih\ELC_Per nm App_040913.d.
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
15855 SW SERENA CT, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
05/08/2013 00:00
ELC2013-00224
FAIL
Wrong address on permit, inspection passed but needs recalled with correct address
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
15855 SW SERENA CT, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
05/08/2013 00:00
ELC2013-00224
FAIL
Wrong address on permit, inspection passed but needs recalled with correct address
Violation Summary:
Inspector Contractor