Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00710
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/02/2013
Parcel: A08000
Jurisdiction: Tigard
Site address: 9115 SW 69TH AVE
Project: Joe Dunne Subdivision: KINGS VIEW Lot: 73
Project Description: Kitchen Master Bath Remodel. 12/16/13, reprinted to add (1) 200 amp feeder
Contractor: PDX ELECTRIC LLC Owner: KELLAY, CLYDE JR & BARBARA D
7933 WHITFURROWS CT 9115 SW 69TH AVE
DURHAM, OR 97224 TIGARD, OR 97223
PHONE: 503 - 997 -1989 PHONE:
FAX: 503 - 200 -1362
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 12/16/2013 $100.70
Specifics: amps or less
8 crt Branch Circuits w /Purchase 12/16/2013 $59.36
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 12/16/2013 $19.21
Electrical
Type of Const:
Occupancy Grp:
Total $179.27
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 a • • - nce with ap• = ed 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 " TION: Oregon law re• 're • to follow the rules adopted by the Oregon Utility N • cat1 1r-'Center. Those rules are set forth in OAR
952 -00 1010 throu•h OAR 952- 001 -0r: r •btain a copy of the rules or direct questions to OUNC by iag 503. .1987 or 1.800'932.2344.
l ued By: k _ . .; L_ • Permittee Signature: �� \
OWNER INSTALLATION ONLY
The ins i: - •eing 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.
To: City of Tiuer d Community Oevelopmant Peps 2 of 4 2013 -12 -13 21 "I a'03 (GMT) 15032001362 From' rvletrry Pelme,r
F1ECFIVED
Electrical Permit Application FOR OFFICE USE ()N1.1'
City of Tigard DEC 16 2013 DB Received Permit No.. 1.40 0
II - " 13125 SW Hall Blvd.. Tigard, OR
RETDIIGvAisRD Ptan Review OtOther Permit: _ Phone: 503.718.2439 Fax: 5035 D Date/By. f I G A RU Inspection Line: 501639.4175 S I�� Dale Rcadyia lulls (a Sec Page 2 for
Internet: www.tigard or.gov V ON Nottficd/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below).
❑ New construction X Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: _ where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
IR I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of I Sll K VA or
❑ Emergency system. larger separately derived system.
JOB SiTE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A".' E". 1 - 2", "1.3'.
l rs 5 ,_ f Ate.- I ix or or more. Recreational vehicle parks.
City /State/ZIP: 1 �gard f o R/ 97223 ❑ Health - care facilities. ❑ Supply voltage for more than
❑ 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:. oewripiloa i Oh. I Fre. I Taxi 1 •
-' New residential single- or multi - family dwelling unit,
•
Includes attached garage.
Subdivision: tot no.: 1,000 sq it. or les 168 ] 4
Ea. add'! 500 sq. ft. or portion 33.92 i
Tax map /parcel no.: -- _ Limited energy, residential
75.00 2
DESCRIP'T'ION OF WORK (with above sq. ft.)
y Limited energy. multi- family
75.00 2
T • �" �iesi = -a 1 8 Vl a � ' s residential (with above sq. ft.)
Renewable Energy ❑ See Page 2
A d / am f .( ckr- . Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less j 100.70 ta'.10 2
201 amps to 400 amps 133.56 2 j
Name: 401 amps to 600 amps 200.34 2 J
'
Address: 601 amps to 1,001 amps 301.04 2 1
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 I 1
Owner installation: This installation is being made on property that i own which is not 201 amps to 400 amps 125.08 2 I
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
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee, 8 7.42 5 /.3L, 2
Business name: each branch circuit
B Fee for brunch circuits without
Contact name: service or feeder fee. first 56.18 2
branch circuit
Address: Each add'! branch circuit 7.42 2
City/State/ZIP: Miscellaneous (service or feeder not included)
y Each manufactured or modular
67.84 2
dwelling. service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
-
E - mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: f ; J/
�1� 7 v E Signal circuits) or limited- energy Sec
Orr . panel, alteration, orestension. Page 2 2
Address: "7,11,q 5 14h)1_ ur"►"ch4)5 64., Each additional inspection over allowable in any of the abov
P � t rat' CAI l'722-11 Additional inspection () hr min) 66.25/ hr
City/State/ZIP: QQ ��ii '� v,�rr Investigation (I hr min) 66.25/ hr
Phone:�o3) 10 4 '7V
3q '' Fax: (S L.0 • ( .3 ,2 industrial plant(1 hr min) 78.18/hr
� �' Inspections for which no fee is 90.00/ hr
CCB Lie.: Electrical Lie.: cioei Suprv. Lic.:56. its specifically listed (A hr min)
�JJ - ELECTRICAL PERMIT FEES
Suprv. Electrician signature. required;.11 Subtotal: 1(eO,04
lV A r4 9 P Date: Plan review (25% of permit fee):
Print name:
t Q �YI��' State surcharge (12% of permit fee): i a • Z
Authorized signature: TOTAL PERMIT FEE: 171. 1.7
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted complete.
• Number of inspecti allowed per permit. 1 091 _QQ -
I Viuild _ ing3Permits3ELC ermaApp _ ERE .doe Rev05(21(2013 440.451 51(11/5S.K'OM/wEt3 PA ip 121. 1 1 419 * 5R to
To: City of Tigard Community pawl op merit Page 1 of 4 2013 -12 -13 21:18 03 (OMT) 15032001362 From: Marty Palmer
RECB
FAX COVER SHEET DEC 16 2013
CITY OFTIGARD
TO City of Tigard Community Development BUILDINGTIIVISION
COMPANY
FAX NUMBER 15035981960
FROM Marty Palmer
DATE 2013 -12 -13 21:17:34 GMT
RE PDX Electric - Add to Existing Electrical Permit
COVER MESSAGE
I need to add a 200amp feeder to an existing permit (ELC2013- 00710) per an inspection
correction. I was not sure how to calculate the fees, so I filled out an application as if I
did it from the beginning, and then deducted what we have already paid. Please call if
you have any questions. We should only owe $58.18. Thank you, Kelly Palmer 503 -
639 -9708.
WWW.METROFAX.COM
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9115 SW 69TH AVE, TIGARD, OR, 97223 2013 -12 -04 (null)
Record Type: Record ID:
Residential - Electrical ELC2013 -00710
Inspection Type: Result:
120 Electrical rough -in FAIL
Comments:
Job incomplete will recall the inspection
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
9115 SW 69TH AVE, TIGARD, OR, 97223
Residential - Electrical
120 Electrical rough-in
2013-12-06 (null)
ELC2013-00710
FAIL
Called twice as requested No answer
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9115 SW 69TH AVE, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
May 6, 2014 at 1:09:09 PM
ELC2013-00710
Jeff Grove
Violation Summary:
Inspector Contractor