Permit III CITY OF TIGARD ELECTRICAL PERMIT
i. , COMMUNITY DEVELOPMENT Permit#: ELC2014-00202
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/28/2014
T I C�aA R i7 g Parcel: 2S 111 C D05600
Jurisdiction: Tigard
Site address: 9580 SW BRENTWOOD PL
Project: DUNAWAY Subdivision: SUMMERFIELD NO.9 Lot: 515
Project Description: (5)branch circuits for kitchen remodel.
Contractor: POWER ELECTRIC INC. Owner: DUNAWAY, DOLORES A
PO BOX 14692 MITHA,WHITNEY D
PORTLAND, OR 97293 MITHA, JASON A
1 JEFFERSON PKWY#329
LAKE OSWEGO, OR 97035
PHONE: 503-786-6930 PHONE:
FAX: 503-786-5462
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo/Purchase 04/28/2014 $85.86
Specifics:, Service or Feeder
1 ea 12%State Surcharge- 04/28/2014 $10.30
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
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 ob- • =copy o -rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. 1
Issued By: iri«t/ =mss Permittee Signature: \
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.
I"
' ' Electrical Permit Application �T Ft)R c)Frl( 1: t'SF ONl^l
City of Tigard CE�v i� DateBea a. �I` Permit No.:
■ 13125 SW Hall Blvd.,Tigard,OR Plan Review
IN I Phone: 503.718.2439 Fax: 503.598.1960 +A
Date/By: Other Permit:
T 1 C A R p Inspection Line: 503.639.4175 p $`t�1`� Date Ready/By: 1 r BI See Page 2 for
Internet: www.tigard-or.gov AQR f+ Notified/Method: Supplemental Information
TYPE OF W o ' • IV:' .. >PLANY R VIEW,•!!+ Please check all that apply(submit 2 sets of plans w/items checked below):
❑New constructionddition/altera t�
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑ ther: �u1L where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONS'>itUCIlON i it exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
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.:;171,-f��g Job site address:95 go SMr "iQ 17� 100 or or more. occupancy.
1 cSZ r ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: Cr�'�y ❑Health-care za do locations facilities. ❑Supply voltage for more than
` ❑Hazardous locations 600 volts nominal.
Suite/bldg./apt. no.: Project name: "2:21.,1/4v1 RW ps/1 CI Service or feeder 600 amps or more.
JJ ' '`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'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 75.00 2
11�� ` DESCRIPTION OF WORK (with above sq.ft.)
k�ck.a...+ C�tv-vt el i\ NSW Cam✓
4,th a tq� Li esid energy,muabove sq. 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
i(0 f-0, �,f f`\.-/1f Q is Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OV1!ER I ❑ , may'[. 200 amps or less 100.70 2
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 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,per panel
❑ APPLICANT ❑ CONTACT 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 D SC c] 2
branch circuit
Address: Each add'I branch circuit -/ 7.42 027,4A; 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: O Nit/ e -A..' a Signal circuit(s)or limited-energy - See
panel,alteration,or extension. Page 2 2
Address: i (32.10.-4, /7 Q l� Each additional inspection over allowable in any of the above
O M O� 91Q27 3 Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: '
Investigation(1 hr min) 66.25/hr
Phone: ) e3t,--•Cc1'jO Fax: '2 g,—54 6Z Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.:/l15Q0 1 Electrical Lic.: 400 Suprv. Lic.: y4155 5 specifically listed('Ahrmin) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
Subtotals
�)w f-' ( Plan review(25%of permit fee): —r
Print name:—if-^! Q Date:
State surcharge(12%of permit fee): b t .-60
Authorized signature: TOTAL PERMIT FEE: t� 1-/This permit application expires if a permit is not obtained thin 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.doc Rev 05/21/2013 440.46 t 5T(I I/05/COM/WEB
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
9580 SW BRENTWOOD PL, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00202
Jeff Grove
Violation Summary:
Inspector Contractor