Permit CITY OF TIGARD ELECTRICAL PERMIT
III I: COMMUNITY DEVELOPMENT Permit#: ELC2013-00704
T t GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/25/2013
Parcel: 1S134CD00300
Jurisdiction: Tigard
Site address: 11995 SW KATHERINE ST
Project: YOUNCE Subdivision: LERON HEIGHTS NO.3 Lot: 73
Project Description: Panel replacement.
Contractor: OAKLEY ELECTRIC INC Owner: YOUNCE, LULA I
12042 SE SUNNYSIDE ROAD, SUITE 500 11995 SW KATHERINE ST
CLACKAMAS, OR 97015 TIGARD,OR 97223
PHONE: 503-855-4719 PHONE:
FAX: 503-908-1729
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 11/25/2013 $100.70
Specifics:, amps or less
1 ea 12%State Surcharge- 11/25/2013 $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 OAR 952-001-0090. You may obtain a cop ••ect 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:
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.
Nov 21 13 10:09a Oakley Electric RECEIVED 503-908-1729 p.1
Electrical Permit Application FOI2 OFFICE t sr fl\L\
City of Tigard NOV 21 2013 Received Permit�o.:
Date03v: i l�� f 3 4.6_a t,0-0 07x'7
• 13125 SW Hall Blvd.,Tigard,OR 97223 plan RVjew'
' C •' Phone: 503.7182439 Fax: 503.5 DaterBy:
Other Permit:
rt`_ P l� inspection Line: 503.639.4175 OF TIGARD Date Ready/By: turfs. SS See P get for
Internet: www.tigardor.gov BUILDING DIVISION Notified/Method: .7. 4 Supplem otal loformatioo
a YPE OF WORK PLAN REVIEW 1
IE
El
construction Addition/alteration/replacement Please check all That apply(submit 2 sets of plans w/ir• .checked below):
❑Demolition Other: where Service or feeder 400 amps or more ❑Building. cr three stories.
where the available fault current ❑Marinas ..boatyards.
CATEGORY OF CONSTRUCTION ex Beds 10,000 amps at I 50 volts or ❑Floating. tidings.
less to ground.or exceeds 14,000 ❑Commerc,1-se agricultural
rd
1-and 2-family dwelling ❑Cotnmerciallindustlial ❑Accessory building amps for all other installations, buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑installatio of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergencysystem. larger .. :ely derived system.
❑Addition of new motor load of ❑"A", E", 'I-2","I-3",
` I00HPorsnore. occupant .
Job no.: Job site address: f i 19 J "1 i A t Sr- ❑Receeario.1 vehicle
�-•�.(� ❑Stx or more residential units. puttee.
City/State/ZIP: "1-71c at-6\ C� oil ;� ❑Health-care facilities_ El Supply v ape for more than
/ J ❑Harardous locations. 600 volts ominal.
Suite/bldg./apt.no.: Project name: ❑service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Drat&EIan I Qty, I Pm I Taint I •
New residential single-or multi-family dwelli.g unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq.R.or less 168._- I 4
Ea.add'l 500 sq.ft.or portion 33.•r I 1
Tax map.parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.R.) 75.0 r 2
�..,,��)) /+ n� Limited energy,multi-family
n t 11. l�∎ (A11l residential(with above sq.ft.)
75.Or 2
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,a t or relocation
• ❑ PROPERTY OWNER , ❑ TENANT I 200 amps or less i 100.71 i cr.7 t; 2
Name: , i 201 amps to 400 amps 133. . 2
`�A..�i` \I 0 �c C� r i 401 amps to 600 amps 200. • 2
Address: 601 amps to 1,000 amps 301.5• 2
Over 1,000 amps or volts 552.2. 2
City/State/ZIP: , Temporary services or feeders installation,alt .lion,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59,3. 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.0: 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701.
401 amps to 599 amps 168. 2
Owner signature: Date:
Branch circuits-new,alteration,or extension let•panel
❑ APPLICANT 1 ❑ CONTACT PERSON A.Fee for branch circuits wuh
above service or fader Fee,
Business name: O�� ��J o- each branch circuit 7'4 2
"^ ` a B.Fee for branch circuits without
Contact name: service or feeder fee,first
56.1. 2
,,` ��y ��' branch circuit
Address: 4l`�1 _7!L ( ' Each add'I branch circuit 7.4 2
City/State/ZIP t '7 Miscellaneous(service or feeder not included
I i"v j5 11.1. a 5'2 2-9 )- Each manufactured or modular
-� dwelling.scrvice and/orfeeder 67'8 2
Phone:( i ) cl:-%SS--u.5'_•I� Fax::(�3) w-e- 1 7;2 1 Reconnect only 67.: I 2
E-mail: -40• tJ ( lie.e,<7. Ce \ • Pump or irrigation circle 67.8, 2
CONTRACTOR t � Signor outline lighung 67.8 2
Business name: /L_JCi1,i /- n (• Signal circuits)or limited-energy See
ww�, •• �' panel,alteration,ore ctension. Pa:•2 2
Address: 1 ti � V{1 1� j,,i, Each additional inspection over allowable in a: •of the above
' cr t �� �1 �u?f 1� w S t V Additional inspection('hr min) 66.251 r
City/State/ZIP: i u3L.Ml.i�, Ci r ✓/7 r1�)- Investigation(1 hr min) 66.25/
Phone: 2) ) 9uj-rt514 Fax: )) 60. _ (7�5 Industrial plum(lhrmin) 78-18' r
J Inspections for which no fee is
CCB Lie.: tq 3,5 Electrical Lie.: C4sl Suprv.Lic.:5.-f/7 3 specifically listed('t hr min) 90.110; r
ELECTRICAL PERMIT FE •
Suprv.Electrician signature,required: A r— Subtotal: j DO.-70
Print name: ----- Plan review(25°0 of it fee): 1 DA'
.1 �' v Dam: { �( — State surcharge(12%ofpermit fee): l
Authorized signature: /4....., TOTAL PERIvIrT FEE: l l;1. 7`,1
A
l -- 2 _ This permit application expires if a permit is not oh''. •within lea
Print name: `TO y _ .�kA�� Date: 1
( t( L days after it has been accepted as comp-5e.
• Number of inspections allowed per permit.
t:rBd.itding1Pcrutits\m.0 PermitApp_ELR_EI(L.dat Rev 050!.'2013 440-5.157'111/051COSMAVEB
II I I
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11995 SW KATHERINE ST, TIGARD, OR, 97223 2013 -12 -04 00:00:00
Record Type: Record ID:
Residential - Electrical ELC2013 -00704
Inspection Type: Result:
199 Electrical final FAIL
Comments:
Nobody there at 12:45 pm left a phone message
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11995 SW KATHERINE ST, TIGARD, OR, 97223 2013 - 12 - 05 00:00:00
Record Type: Record ID:
Residential - Electrical ELC2013 - 00704
Inspection Type: Result:
199 Electrical final PASS - No C of 0
Comments:
Identify all circuits in the panel
Violation Summary:
Inspector Contractor