Permit CITY OF TIGARD ELECTRICAL PERMIT
1t COMMUNITY DEVELOPMENT Permit#: ELC2013-00602
Date Issued: 10/09/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S110AD01700
Jurisdiction: Tigard
Site address: 14620 SW 106TH AVE
Project: Caicedo Subdivision: LANG HILL Lot: 14
Project Description: (2)branch circuits for re-bonding water pipe and bathroom light.
Contractor: A&J ELECTRIC Owner: CAICEDO, CARLA SUE
PO BOX 330 14620 SW 106TH AVE
FOREST GROVE, OR 97116 TIGARD,OR 97224
PHONE: 503-359-5891 PHONE:
FAX: 503-359-1981
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 10/09/2013 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/09/2013 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 9 2- 90. Y u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.�800.332.2234
1.800.332.2344.
Issued By: Permittee Signature: d� Xl-A 1.GEe..9-7-76A/
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.
Oct 07 13 02:38p A&J Electric 5033591981 p.2
Electrical Permit Application i• �� i6 FOR of rlcl_ use ONLY.
.
` City of Tigard ocr 7 Ddtey.eve ved /D/4 /3! ". .wit N°Ei �/.3—940C'e
13125 SW HaII Blvd.,Tigard,OR 97223 01- Plan Review r
Phone: 503.718.2439 Fax: 503.598.19 Date/By; Other Permit:
n of rr � �i3- 33
T I Gil i2 D Inspection Line: 503.639.41 75 � GARD Date Ready/By: brig: !/ ® See Page 2 for
Internet: wWw.[lgard-OLgOV Bull/ I ntt��+`/� Notified/Method: -'/.{ Supplemental Information
TYPE OF WORK �n U t.; v dSION V
PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w;items checked below):
111 Demolition Other: where Service or feeder 400 amps or more ❑Budding otter three stories.
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
® 1-and 2-family dwelling ❑Commercial industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑ Master builder ❑Other: ❑Fire pump ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor lead of ❑"A",`E","I-2","I-3 1
Job no.: Job site address: 14620 SW 106th A Ve 1001iP or more occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97223 ❑Health-care facilities. ❑Supply voltage for more than
[(Hazardous locations. 600 volts nominal.
Suite/bldg./apL no.: Project name: C 9i E-, „,0 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: o ncriPtioo I Qty. 1 Fee Total I
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.R.or less 168.54 4
Ea.add'I 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
Rebond water pipe,move&add light in bathroom residential(with above sq.ft.) 75-00 2
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 I 2
Name:Sue Caicedo
201 amps to 400 amps 133.56 ; 2
401 amps to 600 amps 200.34 2
Address: 14620 SW 106th AVe 601 amps to 1,000 amps 301 04 _ 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:Tigard Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
• 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 12508 2
intended for sale,lease,rent,or exchange,according to ORS 447.4-49,670,and 701.
401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits—new.alteration,or extension,r•r panel
❑ APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
1
above service or feeder fee, 7.42 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first 1
36.18 56.18 2
branch circuit
Address: Each add'l branch circuit I 7.42 7.42 2
•
City.'S[ate;ZlP: Miscellaneous(service or feeder not included)
Each manufactured or modular
67.84
Phone:( ) Foe::( ) dwelling,service and/or feeder
E-mail: Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
CONTRACTOR 'Sign or outline lighting 67 84 2
Business name:A&J Electric,Inc Signal circuit(s)ar limited-energy Sec
_panel,alteration,or extension. Page 2 2
Address:PO Box 330 _Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) I 6625/hr
City:State//..1P:Foret Grove,OR 97116 Investigation(1 hr min) 66 251 hr
Phone:(503)359-5891 i Fax:(503)359-1981 Industrial plant(I hr min) 78.I8!hr
Inspections for which no fee is
B Lie.: 959 Electrical Lie.: 34-1c Suprv.Lie.: 5796S specifically listed(%hr min} 90.00!hr
9\ E LECI RICAL PERMIT FEES
Suprv.Electrician signature.required: Subtotal: 63.60
Print name: Jesse Peterson Date: 1017113 Plan review(25%of permit fry)
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: 71.23 L.---**".."
I: Print name: Date: This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete-
' Number of inspections allowed per permit.
r:rH":""D`Penntu`ebc Pcrtni'APP_ t.R-ErtE.dw
Ray Oars 'wit 444-4615T(Ili 051COMJWED
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14620 SW 106TH AVE, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
2013-10-29 (null)
ELC2013-00602
PASS - No C of O
Violation Summary:
Inspector Contractor