Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit: ELC2013 -00305
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 06/03/2013
Parcel: 2S110BB01500
Jurisdiction: Tigard
Site address: 14405 SW HAZELHILL DR
Project: Houeland Subdivision: AMES ORCHARD Lot: 10
Project Description: (8) branch circuits for kitchen remodel.
Contra ctor: KODIAK ELECTRIC, LLC Owner: HOUELAND, DUSTIN L & ELIZABETH N
8486 SUNNYSIDE RD 14405 SW HAZELHILL DR
SALEM, OR 97306 TIGARD, OR 97224
PHONE' 503 - 881 -1259 PHONE
FAX: 503 - 391 -2611
FEES•
Quantity Description Date Amount
8 crt Branch Circuits wo /Purchase 06/03/2013 $108.12
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/03/2013 $12.97
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $121.09
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 - 0 09 . You ay 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:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date: 6_ 3 ^ 13
LICENSE NO. 5 , r 3
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.
To. Pogo :3 or 3 2013 -05 -30 19 51:52 (OMT) 15039253512 From S - mono Zob, lot
Electrical Permit Applicag C"T"d"` FOR OFFICE USE ONLY
•
1 Received /1l�/
City of Tigard PrIAY 3 ®.7.313 D,,,at, 3 /3 I'enni, No.�C f3 _003 5
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 50 Receve Other Permit.
TIGARD Inspection Line: 503.639.4175 `L ���I��� id Da:cReady/By: ) urtr' ES See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method T/ 6" *" Supplemental Information
TYPE OF WORK . ' PLAN REVIEW
❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 2 sets of plans +v/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 ISO volts or ❑ Floating buildings,
less to ground, or exceeds 14,000 ❑ Commercial agricultural
® I- 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
300` $1T)~ IPr$ RMATIQN AND LOCATIOPV_ ❑ Addition of new motor lead of ❑ "A" "F" "I -2" "l -3" •
Job no.: Job site address: I"NDSSC.L Haw( pill more more occupancy.
❑
H ❑Six or mor residential units. Recreational vehicle parks.
City /Slate /ZIP: 1 1 4 0 ra- ci ?aaq ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or fader 600 amps or [-.G , more.
py '` FILE SClilrDULE.
Cross street/directions to job site: YD (AA ' 11 Y -� / /l(AZe ( f / iT I —� f'ACr' nr,rrloltnn I oty. I Fee. I Thal 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'I 500 sq. ft. or portion 33.92 I
Tax map /parcel.no.:
Limited energy, residential 75.00 2
'‘DESCRIPTION OF WORK . ' , ' (with above sq. ft.)
1 Limited energy, multi - family
• 'l f ,, c It a1L - •r` r, /l •k1le4 Z? I 1 {: � residential (with above sq. ft) 75.00 2
'5' L
Services or feeders installation, alteration, and/or relocation
200 amps or IRss 100.70 2
la PROPERTY' r' . I , ., ■ TENANT, 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 maps to I,0W amps 301.04 2
Address: Over 1,000 tarps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: relocation
Phone: t Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 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
I 10 APPLICANT ❑ C ONTACT 'PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: Kodiak Electric B. Fee for branch circuits without
service or feeder fcc, first
1 56 18 SL ig 2
Contact name: Randy Seiber branch circuit
I Each add branch circuit 7. 7 42 51,q,1 • Address: 22467 SW Ash St Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State/ZIP: Sherwood OR 97140 dwelling, service and/or feeder 67.84
Phone: (503) . 881 - 1259 Fax: : (503) 925 - 3512 Reconnect only 67 84 2
Pump or irrigation circle 67.84 2
I E -mail: shauna@sherwoodtax.com Sign or outline lighting 67.84 2
I CON i R1&CTOB Signal circuit(s) or limited-energy
Business name: Kodiak Electric panel, alteration, or extension Page 2 2
Each additional inspection over allowable in any of the above
Address: 22467 SW Ash St Additional inspection (I hr mm) 66.25/ hr
City /State/Z1P: Sherwood OR 97140
Investigation (I hr min) 66251 hr
Industrial plant (I hr min) 78.18 / hr
Phone: (503) 881 -1259 Fax:-(503) 925 -3512 inspections for which no fee is 90.00 / hr
N 7 specifically listed (V hr min)
CCB Lie.: 161998 / ` ( Electrical Lie.: 5113a� Suprv. Lic.: 6 13-5 5 ) , t L . P g f FEE
4„ ✓ ✓ Subtotal: /OT-19
Suprv. Electrician signature, required: 5-e1� �
Plan review (25% of permit fcc):
Print name: Randy Seiber � Date: 05130 f / 3 State surcharge (12% of permit fee): (,),q7
(; .7"
TOTAL PERMIT FEE: 31
Authorized signature: l This permit application expires if a permit is not obtained N ISO
Print after it has been accepted as complete.
1 rent name: _ Date: • Number of inspections allowed pct permit.
1113uildin5 \Penmu+CLC-PermitApp,doc 07/01/10 440- 1st5T(11 /05 /COMAVCD
To Pnpe oT 3 2013 -05 -30 19 51:52 (GMT) '15039253512 From Shnunn Zobrlmt
FAX COVER SHEET
TO
COMPANY
FAX NUMBER 15035981960
FROM Shauna Zobrist
DATE 2013 -05-30 19:51:32 GMT
RE
COVER MESSAGE
Jenni Kelley
Sherwood Tax
jenni@sherwoodtax.com
Phone 503-925-4558 / Fax 503-925 -3512
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