Permit n CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2013-00651
T[G,ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/29/2013
Parcel: 1S 134DA05300
Jurisdiction: Tigard
Site address: 11252 SW 105TH PL
Project: MILLER Subdivision: NODAK Lot: 1
Project Description: Reconnect only.
Contractor: Owner: STEVE PFEIFER
11252 SW 105TH PL
TIGARD,OR 97223
PHONE: PHONE: 503-803-2689
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 10/29/2013 $67.84
Specifics:
1 ea 12%State Surcharge- 10/29/2013 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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, •r i work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification hose rules are,.set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 5+ t •r 1.800. 2. 44.
Issued By: ��a ��_� 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:
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 ��.F FOR OFFICE IJSI:'ONLY .
City of Tigard �! Received Permit No.: -
�J g Tigard,OR S'*VIII
Date/13 : 10 / 1 BEM/ ��s
a 13125 SW Hall Blvd., gard,O Plan Review
' G • Phone: 503.718.2439 Fax: 503.598.1960 q 9`1013 Date/By:
Other Permit:
T 1 G A K D Inspection Line: 503.639.4175 C1 f+ Date Ready/By: Juris: Ed See Page 2 for
Internet: www.tigard-or.gov O l l� Notifed/Method: 7(y Supplemental plemental Information
� �r► 1 TYPE,of w ��1� PLAN REVIEW
.❑New construction El Addition/alteratg ent
Please check all that apply(submit 2 sets of plans w/items checked below):
UU ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ther: where the available fault current ❑Marinas and boatyards.
.CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to round,or exceeds 14,000 ❑Commercial-use agricultural
-and 2-family dwelling ❑CommerciaUindustrial ❑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 load of ❑"A","E","I-2","1-3",
` IOOHP or more. occupancy.
Job no.: Job site address//� /O / 0 Six or more residential units. p
❑Recreational vehicle parks.
City/State/ZIP: ��A-vr Q e- 97ca3 ❑Health-cart facilities. 0 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'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
(with above sq.ft.) 75.00 2
DESCRIPTION;OF WORK ( 9• ,
Limited energy,multi-family 75.00 2
g�CcW o(v r Y residential(with above sq.11.)
1111 Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
: 0 'PROPERTY OWNER . . ' • , ,0'.TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: Se ,/-� - 401 amps to 600 amps 200.34 2
Address: F lc2S� S7N /057-4 ,lte 601 amps to 1,000 amps . 301.04 2
� Over 1,000 amps or volts 552.26 2
City/State/ZIP: / 0 4� I1� t9' q 3 Temporary services or feeders installation,alteration,and/or
Phone:(` 'J20- 2 6 g/ 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 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
Owner signature: Date: • Branch circuits—new,alteration,or extension,per panel
II APPLICANT 0 r CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
c--.71/1:-U2 ur q R 6tn B.Fee for branch circuits without
Contact name: service or feeder fee,first
branch circuit 56.18 2
Address: Each add'l branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:( ) Fax: :( ) dwelling,service and/or feeder
Reconnect only 1 67.84 67,v/ 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR ' , . , Sign or outline lighting 67.84 2
Business name: Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: , Each additional inspection over allowable in any of the above
City/State/ZIP: Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Industrial plant(1 hr min) 78.18/hr
' Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(IA hr min)
' ' • °ELECTRICAL PERMIT FEES '. "
Suprv.Electrician signature,required: Subtotal: 7,Eci
/ Plan review(25%of permit fee):
Print name: i/ Date: State surcharge(12%of permit fee): 1., fN
Authorized signature- TOTAL PERMIT FEE: ti 9—.,58
16 5/ j am Date•v i. -/� This permit application it has been if a accepted it is not o t red within 180
Print name: i r% , days after it has been acce ted as complete.
" Number of inspections allowed per permit.
I:\Building'Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
• Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined ... $75.00 Description I Qty. I Fee I Total
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems*
15.01 to 25 kva 200.34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
❑ Each additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr
Inspections for which no fee is 90.00/hr
specifically listed(V.hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
❑ 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
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013
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
11252 SW 105TH PL, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
2013-10-30 00:00:00
ELC2013-00651
FAIL
Locked no access
Violation Summary:
Inspector Contractor
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
11252 SW 105TH PL, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
2013-10-31 00:00:00
ELC2013-00651
PASS - No C of O
Violation Summary:
Inspector Contractor