Permit ti CITY OF TIGARD ELECTRICAL PERMIT
g • COMMUNITY DEVELOPMENT Permit #: ELC2013 00739
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/16/2013
Parcel: 1S134DCO5900
Jurisdiction: Tigard
Site address: 11860 SW 113TH PL
Project: Phileo Subdivision: MUTTLEY'S ADDITION Lot: 16
Project Description: Replace panel
Contractor: OMNI ELECTRIC INC Owner: PHILEO
16670 SW WRIGHT ST 11860 SW 113TH PL
BEAVERTON, OR 97007 TIGARD, OR 97223
PHONE: 503 - 747 -0805 PHONE.
FAX: 503 - 649 -2709
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 12/16/2013 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 12/16/2013 $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. AT NTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 010 through OAR 9 -0 You may obtain a copy of the rules or direct questions to OUNC by cattyng.603232.1987 or 1.800.332.2344
Iss ed By: Permittee Signature: iC ea�/� / cA�
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' , L�:,i
�� i �/14111_,;a 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.
Dec.16.2013 10:54 AM
RECEIVED PAGE. 1/ 2
Electrical Permit implication tll< (i 1 l(h 1 ,1' 0"1.' .
City f Tigard Rnceivad f ,'te, , /3 •e�7 .
y ._ C 16 2013 R neviv : / Permit No :
1,1 13125 SW I inn Blvd., Tigard, OR 97223 Pisa Ituview (ilhur Permit!
II ' Phone: 501718.2439 t'ux: 503,598,106(1 %GARU 1 o/11y „
Inspection Line: 503.639.4175 Date Ready /By: tun e: PJ S ee Page 2 for
I I �.: A 1:11 1 Notified /Method; Supplemental Information
Intene: www.tigatd- or.Kef'll1 i . ; SION �
TY OF WORK .. N RE E -
please check all that a gt l ly (submit PLA a seta VI of g W
lens w /items checked below):
❑ New COnStruCtionAdditiol�alteratiorl /replacement p Service or reader 400 amps or more ❑ Building over three stories.
❑ Demolition Q Oyler: where the available fault current I: Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ floating buildings,
less io ground, or exceeds 14,000 ❑ Commercial -use agricultural
1- and 2- family dwelling 0 Commercial /industrial ci Accessory building amps for all other installations, buildings.
1 ❑ Multi•i'amily ❑ Master builder ❑ Other: ❑ lira hulnp, 0 Installation of 1 SO KVA or
_ -- - -- ❑ Inrorgoney system. larger .0 , rarely derived system.
JOB SITE INFORMATION AND L OCATION
�Additiunor now motor load ul' ❑ "A" ")•:" "1.2 "."t -1
—�" , r 100111 or more. occupancy.
Job no , Job site address: �f ] � t
�1..011--. . A � ., ❑ Six or more roslJontinl units • ❑ Recreational vohiulo larks.
(] Health-care fnoilitios, ❑ Supply wimp for nwrc than
City /State /ZIP: `� /��q�� �.7 � 0 1 Itcordous locations. 600 volts nominal
SUItC/b)dg. /apt no.: Project name: 7371/4,g:6 ❑Service or feeder 600 amps or n1urc,
FEE SCHEDULE
Cross strecldirections to job site: .• _p
.
]k (tell Q[ I rUa fat _ _j
_._. - New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision:
Lot no 1,0(X) a1) n or 1 11x4 105,54 4
— . _ --- Ea. udd'15UU sq. It. or ixlrtian 3192 -.. 1
Tax map /parcel no.: - • Limited eno'gy, residential 75 01
DESCRIPTION OF WORK ,(withuhove 1
WORK _ (with energy, multi- family 75,00 7L = I - „ p � residential (with ab eve sq. R.)
!Y R enewable Energy clSOO 2
Services or feeders Installation alteration, snot /ur relocation
❑ PROPERTY OWNER -w ❑ TENANT -.� 200 tulips or less 1181.70 ' ♦ . 7(f 2
201 amps to 400 amps 133,50 2
Name: 4111 11t11p4 W 600 Wmps 20°,34_ - - ...... - ._.. 2
60 i amps to 1,000 amps —
Address: 30 L04 2
Over 1,000 amps or sobs , 552.26 ! 2
City /Slate /ZIP: Temporary services or feeders installation, alteration, and /or
relocation Phone: ( ) Fax: ( ) rel amps or less 59.36 J 1
Owner installation: This installation is being made on property that 1 own which is not 201 amp to 400 amps 125.U8 _
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701, 4111 amps to 599 IN 108.54 2
Owner signature.__. _ _ _•„ Branch circuit. - new, alteration or estenaion. 1 r panel
❑ APPLICANT 1 0 CONTACT PERSON A. Fee for brunch circuits with
— _..._... —___ _.._.. - -- above scrim) or feedt.t fee, 7.42 2
cinch branch circuit .-
Business name 13. bee fur branch circuits without
Contact name: service or feeder fee, first I 56.18 12
_ .. __ brunch circuit __
Address: - r Isuch rule)') branch circuit 7.
Miscellaneous (service or feeder not Included)
City /Blatt /ZIP: Laxhmanufacturedor 1 67.84 2
' ~ dwelling, service and/or feeder
fax: ! ( ) 67.84 2
Phone: ( ) Reconnect only
E -mail: Pump or irrigation circle 67.4 2
_ CONTRACTOR Sign for outline lighting 67.84 _. 2
Business name: f ,ter Signal circuit(x) or 'tinned-energy tic'c
��Nt E � _ / « lancl, ullerntioa, or extension ( P1 ;e 2
r " -- y Each additional Inspection over allowable in any of the above
Address: (, C { 7 [ t� . I w 06. h
Additional inspection (1 hr min) r
City /State /ZIP: 1 hr olio)
TL G- ' 1.7Cx7, ? Investigation (1 hr min) 00.25/hr — —
lJr i
4/ ( 1 78.18 / hr
Phone: ) � Fax: ( � � � .. 7 0 Industrial wtt ..(
_ Inspections for which no lax: ix 90,18)/ hr
CCB Lic.: J7 I Electrical Lic.: Z/ Suprv. Lie.: 'y U .D alaclliullly listed f, hr min
.;. ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: - _ Subtotal ,_1 .7()
Nan review (25% o1:permit fcc):
Print name: ‹• Date:
State surcharge (12% ol'permil fee): i '-•
Authorized signature: TOTAL PERMIT Mk: ! /a7 7g'
_.,, -__ _ This permit appncadon expire. if it perralt Ii not obis4 within 180
Print name'. Date: Jaya after It hail been accepted es complete.
• Number of icepections allowed per permit
1:\ 13udd1nt iParml/n\rs1.('_I'snldcApp ,ILR_tiRE.dut Rev 01111 /2017 40.0- 1615T(i l /aS /COM'WEH
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
11860 SW 113TH PL, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
2013-12-20 00:00:00
ELC2013-00739
PASS - No C of O
Violation Summary:
Inspector Contractor