Permit CITY OF TIGARD ELECTRICAL PERMIT
1111
I COMMUNITY DEVELOPMENT Permit#: ELC2014-00047
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/04/2014
T«''�RD g Parcel: 2S111CD06700
Jurisdiction: Tigard
Site address: 9855 SW KIMBERLY DR
Project: Duffy Subdivision: KERWOOD ESTATES Lot: 20
Project Description: Replace 200 amp panel
Contractor: OWNER Owner: DUFFY,GARY H AND ERAINA J
GARY DUFFY 9855 SW KIMBERLY
15675 NE EILERS RD TIGARD, OR 97223
AURORA,OR 97002
PHONE: 503-539-1345 PHONE: 503-539-7345
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 02/04/2014 $100.70
Specifics:, amps or less
1 ea 12%State Surcharge- 02/04/2014 $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. ATTE ••: •r=,•n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0' 0 through OAR 9 0' •090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344
0f
Issue. c : i ' �1 , 4JA,. I! r Permittee Signature: • �LCN ►di
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: a9/1///11
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 A licatio ii` rE
City of Tigard �j u Date/By: f-y '7 Permit No.:EACAO1 -eye 7
1111 •
13125 SW Hall Blvd.,Tigard,OR 97 Plan Review
g Phone: 503.718.2439 Fax: 503.598.1960E Eg 4 2014 Date/By: Other Permit:
I I is t Inspection Line: 503.639.4175 Date Ready/By: runs: ® See Page 2 for
Internet: www.tigard-or.gov �'�/ Iln�p(Z Notified/Me[hod: Supplemental Information
1�i.o�� u IIL/
TYPE OF W 1.1M��li PLAN REVIEW .
❑New construction ]��Addition/alteratlo reepl'ace�ment Please check all that apply(submit a sets of plans w/items checked below):
b ❑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 ❑Floating buildings.
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 0 Master builder 0 Other:
0 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: "l ESS eI.A.) (,?,",t, 100HP or more. occupancy.
` 1 b�' 1 1� ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: `C-\(�,4'L0 Oil-- 61-1-2--7-2-( ❑Health-care za dor locations. ❑Supply voltage for more than
TVA" ❑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: 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 75.00 2
• DESCRIPTION OF WORK (with above sq.ft.)
9 Limited energy,multi-family
sq.
�rC ��J() z6��4�Q �c��`-'v ��� N�'t'J residential(with above sq.ft.)_ 75.00 2
Renewable Energy _ ❑ See Page 2
20D a-AAP PeA'Oe� ,I, LpLpAl� Services or feeders installation,alteration,and/or relocation
g3PROPER /Q
PROPERTY OWhi$K- -1 ❑ TENANT 200 amps or less / 100.70 b5h 2J
f„ 201 amps to 400 amps 133.56 2
Name: ba Y- Q t l 401 amps to 600 amps 200.34 2
Address: lj e N .- 'Et\--or-', c2—{) 601 amps to 1,000 amps 301.04 2
^ ,��n Over 1,000 amps or volts 552.26 2
City/State/ZIP: tF.d, -0 n� V'`_, 0110 02— Temporary services or feeders installation,alteration,and/or
Phone:( t ) ,j -11i t 6 Fax:( ) relocation
ti 200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease, ent,orange,according to ORS 447,449,670, 401 amps to 599 amps 168.54 2
Owner signature: _%I/_,. '9 Date: o` , c Branch circuits-new,alteration,or extension,per panel
❑ 'CANT I ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, 7 42 2
Business name: I v
B.Fee for branch circuits without
Contact name: service or feeder fee,first
branch circuit 56.18 2
Address: Each add'I branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:( ) Fax: :( ) dwelling,service and/or feeder • -
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: N V�r Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:
Investigation(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Industrial plant(1 hr min) 78.18/hr -
Inspections for which no fee is
CCB Lic.: Electrical Lic.: I Suprv.Lic.: specifically listed( 9p 00/hr
V2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
Subtotal: /00. 7O
Print name: Date: Plan review(25%of permit fee):
State surcharge(12%of permit fee): /? .D g
Authorized signature: TOTAL PERMIT FEE: !/a -7$
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013 440-46151(11/05/COM/WEB
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
IN COMMUNITY DEVELOPMENT Permit#: ELC2014-00047
T t C;A RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/04/2014
Parcel: 25111 CD06700
Jurisdiction: Tigard
Site address: 9855 SW KIMBERLY DR
Project: Duffy Subdivision: KERWOOD ESTATES Lot: 20
Project Description: Replace 200 amp panel.4/7/14:Reprinted permit to add contractor.
r -
Contractor: ROBERTS ELECTRIC INC Owner: DUFFY, GARY H AND ERAINA J
5759 SW 48TH ST 9855 SW KIMBERLY
PORTLAND, OR 97221 TIGARD,OR 97223
PHONE: 503-244-7754 PHONE: 503-539-7345
FAX: 503-244-0560
FEES
Description Date Amount
Specifics: Services or Feeders-200 amps or less 02/04/2014 $100.70
12%State Surcharge-Electrical 02/04/2014 $12.08
Type of Use: SF
Class of Work: ALT
Total Number of Systems:
Audio&Stereo: N
Security Alarm: N
Garage Door Opener: N
HVAC: N
Vacuum System: N
Other: N
Other Desc: 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 copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
1 r �
Issued By ermi a Signature: � v/l.y�rw�1
r (/
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 FOROFF1('I. I :E mI 1
City of Tigard ��vVj Received
Date/By: Permit No.: F,,-4....c of C.)7 i t— c Y 7
13125 SW Hail Blvd.,Tigard,OR 97223 5 Plan Review
Phone: 503.718.2439 Fax: 503.598 'j .. - : Other Permit:
! 1 Inspection Line: 501639.4175 i� Date Ready/By kris. id Sae pip 2 far
Internet: www.tigard-or.gov Neufied/Meth d _ Sr pple mwdal I'foneatioa
❑New construction ■Addition/alteration/ 1� Please check a9 apply(submit j of plans checked below):
lv1s 0 ❑Service or feeder 400 amps or more ❑Building over three stories
❑Demolition ❑Other: ✓ where the available fault current
0 Marinas and boatyards.
OF CON r:',51.:=<'�' -r ---.'77.,777- ' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to grand,or exceeds 14,000 ❑Commercial-use agricultural
IN 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other OFire pump. ❑Installation of 150 KVA or
- -.. -,v :.-,.. ; Emergency system. larger separately derived system.
:-•JOB Srl'E' ORMATIOf'4,QID "> - __
.... - _ '':- .'. O Addition of new motor load of ❑"A""E",`9-2""1-3"
Job no.: Job site address: 100HP or more. occupancy.
5 ek), O Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: 'a l ❑Health-care facilities. ❑Supply voltage for more than
(s _ ❑Hazardous locations. 600 volts nominal. III
Suite/bldg./apt no.: -1 Project name: s N A, II I' / ❑Service or feeder 600 amps or more.
hi FEE SCHEDULE:
Cross street/directions to job site: Deacriptleo I Qa. I Fee. I Tate' I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
S► 1,6_3, 1,000 sq.ft or less 168.54 4
Subdivision: Lot
Ea add'E 500 sq.ft or portion 33.92 1
Tax map/parcel no
Limited energy,residential
_ �p _ ._... ...��..:�.. .-; 75.00 2 '
.r,'-•'iV B v(W OI T,::.`'~_ ,.'� y:�, :r.:,_'. (with above sq.ft.)
Limited energy,multi-family 75.00 2
.Rd LC-6- � ,re residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
:. ,.., S 200 amps or less f 100.70 2
201 tlrtgrs 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:( ) I Fax:( ) relocation
200 amps or less 59.36 l
Owner installation:This installation is being made on property that I own which is not -201 amps to 400 amps 12508 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,
_ .,. ,...,. , � a,per panel
-
0 MPLT1NIl...'= ` . . Q rACT::PERSON
- A.Fee for branch circuits with
above service or feeder fee, 7.42 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first 56.18 2
branch circuit
Address: Each add'I branch circuit 7.42 2
Crty/State/Z1P Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phi:( ) I Fax::( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
n, y.
401!1•tlE,TtilC'. Si go or outline lighting 67.84 2
Business name: V.osetzx S C'zt%1 L W-iIIC Signal ttt(s)or!linked-energy See
panel,alteration,or extension. Page 2 2
Address: 5--7 5 .5 S- ti-•aj• ccef Each additional inspection over allowable in any of the above
(n�nn Additional inspection(1 hr min) 6625/hr
City/State/ZIP: Y fJ 7, d 2Ze Investigation(1 hr min) 6625/hr
Phone:(rcsZ o 4L4— s'f I Fax:(3c3)a>a g —O SAO Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
90.00/hr
CCB Lie: ¶43 Electrical Lie.:3 23'- I Suprv.Lie.: 3R1(I 5 specifically listed(14 hr min)
tp t f ELSt`:'FRICAL PERMIT:'PEk << ^w' %::••::
Suprv.Electrician required:
5,04.4.0.: y ��0.
Subtotal
Print name: rp ^ `r pt�0�( /1 I �� 47 f i Li Plan review(25%of permit fee):
�L�f,� J J // 1/ State surcharge(12%of permit fee): /2-
Authorized signature: TOTAL PERMIT FEE: //2. 4
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
l:lBuilding\Permils\ELC PermitApp_ELR_ERE.dec Rev 05/21/2013 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: 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
nBurglar 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
❑ Heating, Ventilation and Air Conditioning OAR 918-309-0040) 552.26 2
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: Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr
Inspections for which no fee is 90.00/hr
specifically listed(1/2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State 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
nAudio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1.\Building'P ermits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013