Permit u CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2014-00004
Date Issued: 01/08/2014
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S109DA10700
Jurisdiction: Tigard
Site address: 12946 SW BLACK WALNUT ST
Project: Summit Ridge No.2 Subdivision: SUMMIT RIDGE NO.2 Lot: 96
Project Description: Electrical reconnect for pathway light pole into common area.
Contractor: Owner: TUCKER, SAUNDRA
12946 SW BLACK WALNUT ST
TIGARD,OR 97224
PHONE
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 01/08/2014 $67.84
Specifics:
1 ea 12%State Surcharge- 01/08/2014 $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 = .r.ance 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. ; ENTION: Oregon :w requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-I.1-0010 through OAR 952-0 h ••.. You may obtain a copy of the rules or direct questions to OUNC by calli 503232.1987 or 1.800.332.2344.
Is=ued By: /d' - `lf r � Permittee Signature: �a (\ 1�
�`J
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`ECEIVED FOR OFFICE USE ONLY
City of Tigard I Dateived %e� J� /^ q'-,'/ �
II q Permit No.: f� 'T'
13125 SW Hall Blvd.,Tigard,OR 97223AN ® 7 2014 Plan Review
M ` .- Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov
Notified/Method:otifed/Method: SupplementalInformation
Bgp NG DIVISION TYPE OF WORK
PLAN REVIEW
❑New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three smiles.
❑Demolition E Other: Reconnect where the available fault current ❑Marinas and boatyards.
. CATEGORY OF CONSTRUCTION', rte; ,:1;,,∎;1;; exceeds 10,000 amps at 150 volts or ❑Floating buildings.
• h '' less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ®Other:HOA ❑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","I-3",
Job no.: Job site address: 12946 SW Black Walnut St 100HP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97224 ❑Health-care facilities. ❑Supplylnominal.
y ltage for more than
❑Hazardous locations.
Suite/bldg./apt. no.: Project name: ❑Service or feeder 600 amps or more.
4:.' ,,y FEE SCHEDULE
Cross street/directions to job site: SW Black Walnut Street Description I Qtr- 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
' ,;r. ,:r, ",:'�': :'°> DESCRIPTION OF WORK ( q
Limited energy,multi-family 75.00 2
Reconnect existing walkway lighting pole at pathway in HOA common area residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
1-branch circuit Services or feeders installation,alteration,and/or relocation
+� t,-. 200 amps or less 100.70 ' 2
❑ PROPERTY•�OWNER� .. 7"` -'�;; ',,''- �.'TENANT ':�'' p
201 amps to 400 amps 133.56 2
Name: 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 I
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
,'fib-:.., A.Fee for branch circuits with
® APPLICANT:,+,`c: ❑;CONCACT, PERSON above service or feeder fee,
7.42 2
Business name:Summit Ridge HOA do The Management Group,Inc.
each branch circuit
B.Fee for branch circuits without
Contact name: Dominica Culver service or feeder fee,first 56.18 2
branch circuit
Address: 15350 SW Segr eirJul&p■ .W' 'LOO Each add'I branch circuit 7.42 2
City/State/ZIP: Portland,OR 97224 Miscellaneous(service or feeder not included)
Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Phone:(503)598-0552 Fax: :(503)598-0554
Reconnect only / 67.84 Z07.15(1 2
E-mail:dominica.Culver @tmgnorthwest.com Pump or irrigation circle ( 67.84 2
' ,1:'.- ,-,IF 'I CONTRACTOR A:;- ;I' .. - _• _ 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(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: Electrical Lic.: Suprv.Lic.: specifically listed('/hr min)
,?+ :_': ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 6,7, -9-
Print name: Date: Plan review(25%of permit fee): ,----"
State surcharge(12%of permit fee): g-(51
Authorized signature TOTAL PERMIT FEE: 7 .9 it
This permit application expires if a permit is not obtained within 180
Print name �Ornl 1 ca. Date: 1 j days after it has been accepted as complete.
•
`'� Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 4404615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
�RESIDENTIA WORK ONY;X:' r,. FEE SCHEDULE
Fee for all residential systems combined. $75.00 Description I Qty. I Fee I Total I
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
n 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
❑ Heating, Ventilation and Air Conditioning OAR 918-309-0040)
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: 1 branch circuit Each additional inspection is 66.25/hr
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
�y
specifically Ily listed %:hr min)
CONIlVII;RCIL,yvQlrQVY.S�:''" - =:.Is+; ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
Statc 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.
n Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
Cl Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n 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 Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12946 SW BLACK WALNUT ST, TIGARD, OR,
97224
Residential - Electrical
199 Electrical final
2014-01-10 00:00:00
ELC2014-00004
PASS - No C of O
Violation Summary:
Inspector Contractor