Permit I , � CITY OF TIGARD ELECTRICAL PERMIT
II s COMMUNITY DEVELOPMENT Permit #: ELC2013 00737
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/11/2013
Parcel: 2S112BCO5800
Jurisdiction: Tigard
Site address: 8420 SW LA MANCHA CT
Project: Fannie Mae Subdivision: LA MANCHA ESTATES Lot: 11
Project Description: Electrical reconnect only
Contractor: Owner: FANNIE MAE
8420 SW LA MANCHA CT
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 12/11/2013 $67.84
Specifics:
1 ea 12% State Surcharge - 12/11/2013 $8.14
Electrical
Type of Use: SF
Class of Work: OTR
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, or if work is suspended for more the 180
days. ATTENTION: O I requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 throu OAR 952 -001 0090 u m obtain a copy of the rules or direct questions to OUNC by callin. _e_ . 2.1987 or 1.800.332.2344.
!�/
Issued By: Permittee Signature: - _ � ✓ _ 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.
Electrical Permit Application FOR OFFICE USE ONLY
g DEC EIVED D ate / BBy At / //, 3 L eke /3-i 7E9
Cl of Tigard Received Permit No.:
" 13125 SW Hall Blvd., Tigard, OR 972 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov DEC 10 2013 Notified/Method: Supplemental Information
F YI'l: OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alterafio Please check all that apply'(submit 2 sets of plans w /items checked below):
� j� 15� O1\ ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Other: E(e '(`#''( L C ), A no. L — 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
Ell - 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 load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: C 11'' < 1 . I I CA-
10o1-IP or more. occupancy.
C1 N �� } )Y V Li 1y � l�Q ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 7 c)(1._ q-i72 -/ 113 Health-care facilities.
El Supply voltage for more than
"/ El Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: c,41'A)101 tiA-E__ ❑ 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'l 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 75.00 2
EI e L"� ((Ci � C 0 (Lad-
. Q C J' residential (with above sq. ft.)
Renewable Energy ❑ See Page 2
_�—p'1 - X? (.4 (51" Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: Cct r-) n( a , &Q-. 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State /ZIP: 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 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, .er panel
❑ APPLICANT XL CONTACT PERSON A. Fee for branch circuits with
1 /7 above service or feeder fee,
Business name: �rksh l re_ � T L jai N u) l.&cJ / L at , each branch circuit 7.42 2
Nu) `� B. Fee for branch circuits without
Contact name: Lajo V(A_ a ITY/ 62.4i service or feeder fee, first
branch circuit 56.18 2
Address: 33 ( E CoLe.,till G a_ Ave. *I U Each add'l branch circuit 7.42 2
City /State /ZIP: US (D Miscellaneous (service or feeder not included)
Se (Q 9 ( -7 Each manufactured or modular
Phone: (5 � Fax: G - 2. dwelling, service and/or feeder 67.84 2
1 �� 0 p /81 - � �� ( / C �) x `� Reconnect only ! �� a 67.84 c, 2
E -mail: a J(� ) C D . � "r b Pay I fl � cAi , (�1 ' Pump or irrigation circle + 67.84 � 2
CONTItACFOR 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
Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP:
Investigation (1 hr min) 66.25/ hr
Phone: ( ) Fax: ( ) Industrial plant (l hr min) 78.18 / hr
Inspections for which no fee is 90.00/ hr
CCB Lie.: Electrical Lie.: Suprv. Lic.: specifically listed (%S hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: L-7, gU
Plan review (25% of permit fee):
Print name: Date:
State surcharge (12% of permit fee): S t ,
Authorized signatur TOTAL PERMIT FEE: '75. CA
This permit application expires if a permit is not obtained within 180
Print name: D ,ca a t(4 vl A Date: 1, 2-3- 1- days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Pennits\ELC PemiitApp_ELR_ERE.doc Rev 05/21/2013 4404615T(1I/05/COM/WEB
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
8420 SW LA MANCHA CT, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
2013-12-19 (null)
ELC2013-00737
PASS - No C of O
Reconnect only
Violation Summary:
Inspector Contractor