Permit CITY OF TIGARD ELECTRICAL PERMIT
INCOMMUNITY DEVELOPMENT a#Permit : ELC2014-00300
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13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/03/2014
TIGARD Parcel: 2S110AD90054
Jurisdiction: Tigard
Site address: 14946 SW 109TH AVE
Project: CAMPBELL Subdivision: CANTERBURY WOODS CONDO Lot: 54
Project Description: Reconnect only.
Contractor: Owner: CAMPBELL, KRISTY N
14946 SW 109TH AVE
TIGARD, OR 97224
PHONE:
PHONE: 503-740-3509
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 06/03/2014 S67 84
Specifics:
1 ea 12%State Surcharge- 06/03/2014 58.14
Electrical
Type of Use: MF
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 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 otfpy of the rules or direct questions to OUNC by calling 503.232.1987 or 1 800 332 2344
Issued By: !/` _ - - 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.
Electrical Permit Application MR K I 1 I I( I I ,I u I.1
City of Tigard Received
/B , nral '
74
• 13125 SW Hall Blvd.,Tigard,OR 9723 Plan Review — J,
■ Phone: 503.718.2439 Fax: 503.598.1960
Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: el See Page 2 for
I I`' \I:I I Internet: www.tigard-or.gov eka Notified/Method: Supplemental Information
°
TYPE OF WO)t V1a n�1� PIAN REVIEW,
To
❑New construction ❑Addition/alteratio repiitbement Please check all that apply(submit Z.sets of plans w/items checked):
❑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.
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
•j Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
19 S l to C 4) [O1`r_ ❑Addition of new motor load of system.
Job#: Job site address: cJ '�T't 100HP or more. ❑"A","E","l-2","1-3",
�� ❑Six or more residential units. occupancy.
City/State/ZIP: t i l�p / 0 2 9 '7 a a. ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ` ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
'r Tax map/parcel#: I,000 sq.ft.or less 168.54 4
Ea.add'1 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
S NS pec-r EL E C-r Rz cZ Lx 0C-: m,t2 F.,(4 I-0- (with above sq.ft.)
1✓ 5 Limited energy,multi-family
$660 O F f -y E 1-1 i A n) 67 vv-r14,5 residential(with above sq.ft.) 75.00 2
t ry ��J Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER TENANT Services or feeders installation,alteration,and/or relocation
Name: 'E G C ,yt P rfS a LL 200 amps or less 100.70 2
Address: 9 c g b S L. I I (Q 0 c D 201 amps to 400 amps 133.56 2
` 401 amps to 600 amps 200.34 2
City/State/ZIP: Tx= flu x._1—,0 A.) 0 2 7 Z C77 601 amps to 1,000 amps 301.04 2
Phone:603 ) 31-1 -S /3 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: 0MTV\pi)e LL. (,O f hecte lrytQt l'C-ot^'I relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale, lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
❑ APPLICANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only f 67.84 6 7 2
CONTRACTOR Pump or irrigation circle 67.84 tt 2
Business name: Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy CI See Page 2 2
panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 66.25/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(/2 hr min)
ELECTRICAL PERMIT FEES _
Suprv.Electrician signature,required: Subtotal: 7-76-1
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):_ g,/Pt -
Authorized signature: C'.- • TOTAL PERMIT FEE: g Ci 8 I.
•
cT This permit application expires if a permit is not obta ed within I80
Print name:`Co 6 J 3- C on v�� a(.,L Date:(p/.3/a Q 1 Ci days after it has been accepted as complete.
i r • Number of inspections allowed per permit.
1:\Building\Penni ts\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 4404615T(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
Description I Qty. I Each I Total I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* 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 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('A hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
• Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ 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
I.\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014
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
14946 SW 109TH AVE, TIGARD, OR, 97224
Commercial - Electrical
199 Electrical final
PASS - No C of O
June 4, 2014 at 8:43:17 AM
ELC2014-00300
Jeff Grove
Violation Summary:
Inspector Contractor