Permit CITY OF TIGARD ELECTRICAL PERMIT is
1114 II • COMMUNITY DEVELOPMENT Permit#: ELC2014-00290
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/29/2014
Parcel: 2S102DD01500
Jurisdiction: Tigard
Site address: 8740 SW OMARA ST
Project: SEYMOUR Subdivision: EDGEWOOD Lot: 8
Project Description: Adding(4)circuits and altering(1)existing circuit.
Contractor: ERIC OLSON ELECTRIC COMPANY Owner: SEYMOUR, LEN
10013 NE HAZEL DELL AVE PMB 432 5424 WOODSHIRE CIR
VANCOUVER,WA 98685 ANCHORAGE,AK 99516
PHONE: 360-609-4901 PHONE:
FAX: 360-693-2980
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo/Purchase 05/29/2014 $85.86
Specifics: Service or Feeder
1 ea 12%State Surcharge- 05/29/2014 $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 issuan = or if work is suspended J/more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notrficatio - er. Those r are t forth in OAR
952-001-0010 through OAR 952-001-0090. You m a co y oft cectt questions to OUNC by calling 50 87 or 1.8r r 44.
,( /
Issued By: Permittee Signature: . z �i94 c
NER 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 1 l()ll ()I ii( 1 I 1 ().1 ,
City of Tigard \\csr 1Ved
��+ I ,iI Permit No.: Al'''0 1-uJ
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review a Phone: 503.718.2439 Fax: 503.598.196( pt Date/By: alter Permit: RI_/il�i f y-ev i 7,
• �0
I I t∎.1 r i Inspection Line: 503.639.4175 P� 29 Date Ready/By: tans: El See Page 2 for
Internet: www.tigard-or.gov M ttfied/Method: - ( Supplemental Information
TYPE OP WORK tt�� ter t� PI<.i�rl REVIEW
Please check all that apply(submit 2 sets of plans w/items checked below):
New constructionddition/alteration/reg
❑Service or feeder 400 amps or more ❑Building over three stories.
Demolition ❑Other where the available fault current 0 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 ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
• ❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A° "E° `1-2°`1-3"
Job no.: Job site address:8740 SW Omara St IdoliP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Seymour ❑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 I
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family
75.00 2
House model-adding 4 new circuits and altering one existing circuit residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
!:s PROPERTY OWNER I 0 TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name:Nate Seymour 401 amps to 600 amps 200.34 2
Address:8740 SW Omara St 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:Tigard,OR 97223 Temporary services or feeders installation,alteration,and/or
Phone:(503)545-6538 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,Rer panel
0 APPLICANT I 0 CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, 7.42 2
Business name:Eric Olson Electric Inc each branch circuit
B.Fee for branch circuits without
Contact name:Eric Olson service or feeder fee,first 1 5618 56.18 2
branch circuit
Address: 10013 NE Hazel Dell Ave PMB 432 Each add'l branch circuit 4 7.42 29.68 2
City/State/ZIP:Vancouver,WA 98685 Miscellaneous(service or feeder not included)
Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Phone:(360)609-4901 Fax: :( )
Reconnect only 67.84 2
E-mail:ericolsonelectric@gmail.com @g Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Eric Olson Electric Inc Signal circuit(s)or limited-energy See -
panel,alteration,or extension. _ Page 2 2
Address: 10013 NE Hazel Dell Ave PMB 432 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Vancouver,WA 98685 Investigation(1 hr min) 66.25/hr
Phone:(360)609-4901 Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90 O()/
CCB Lic.: 179408 Electrical Lic.: 37-1053C Suprv.Lic.: 4910S specifically listed(Y2 hr min) lir
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 85.86
Print name: Eric Olson Date: 05/27/14 Plan review(25%of permit fee):
r State surcharge(12%of permit fee): 10.30
Authorized signature: TOTAL PERMIT FEE: 96.16
This permit application expires if a permit is not obtained within 180
Print name: Eric Olson Date: 05/27/14 days after it has been accepted as complete.
- • Number of inspections allowed per permit.
I:1Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(11/05/COM/WEB
■
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
8740 SW OMARA ST, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00290
Herb Stabenow
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
8740 SW OMARA ST, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00290
Herb Stabenow
Violation Summary:
Inspector Contractor