Permit CITY OF TIGARD ELECTRICAL PERMIT
II s • COMMUNITY DEVELOPMENT Permit#: ELC2014-00483
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/27/2014
Parcel: 1 S134DB03100
Jurisdiction: Tigard
Site address: 11140 SW NORTH DAKOTA ST
Project: CLARK Subdivision: WINTERS ADDITION Lot: 6
Project Description: Replacing(1)30 amp breaker in the panel.
Contractor: RIGHT NOW HOME SERVICES INC Owner: CLARK, MARIE M
BOX#701 12042 SE SUNNYSIDE RD 11140 SW NORTH DAKOTA
CLACKAMAS OR 97015 TIGARD, OR 97223
CLACKAMAS, OR 97015
PHONE: 503-490-9471 PHONE:
FAX: 503-775-6006
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 08/27/2014 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/27/2014 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 otherdier,le 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, o ork� ded for more the 180
days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification C- r ules -•e set forth in OAR
952-001-0010 through OAR 952-001-0090 You may o• - opy of the rules t ect questions to OUNC by calling 503.23 - •. :4/ /
'� �'�
Issued By: Lti� _ •ermittee Signature: i, LL,f--_
—rte
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 j1 COVE I I t iR 1 II I I( I I `I ()\1 1
WW 1J1 Received
City of Tigard Date/B : 1 /( ..1/1" Permit#: `(.l All
1111111 • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
• Phone: 503.718.2439 Fax: 503.598.1960 ttG 2 1 2414 Related Permit#:
^ Date/By:
Inspection Line: 503.639.4175 A u •eady Date/By: hair ® See Page 2 for
I I t. 'I`D Internet: www.tigard-or.gov Nr. otified/Method: 7�G Supplemental Information
�T'E OF WORK ,��T�. [ Dt igt •, PLAN REVIEW
❑New construction 1 .dditi0n/alteratio nt Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 snips or more ❑Building over three stories.
❑Demolition 0 Other:
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
■@ d 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND f ,9 ❑Emergency system. larger separately derived
Job#: I Job site address: I I ' 1+0 Ski �� /'7 ❑Addition of new motor load of system.
I OOHP or more. ❑"A" "E" "i-2" "1-3"
f / ❑Six or more residential units. occupancy.
City/State/ZIP:
s GAit ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I 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 1 Qty. I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: •
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
" / A so ,. A '1'x ;,1 a Q af (with above sq.ft.) 75.00 2
�t+^� K-1�- r r � Limited energy,multi-family 75.00 2
�,q ` G N , 1_dG residential(with above sq.ft.)
id �1G Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: 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: .5AA as 6?-4 Lv r above service or feeder fee,
�^v each branch circuit 7'42 2
Contact name: B.Fee for branch circuits without
Address: branch it feeder fee,first I 56.18 ,�ir 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: ,6fir A)Q-2A. grxra-
gax Ut'c_cj ..z.,,-c. Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: panel,alteration,or extension. g
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(5o'g yqo 747 / I Fax:( ) Investigation(1 hr min) 66.25/hr
Email: t Industrial plant(1 hr mm) 78.18/hr
CSS Ply` `� 6#4,at 1 s Cam Inspections for which no fee is
CCB Lic.: 11 34.02, Electrica or Prv. ic.:all W s specifically listed(V5 hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician stj �e,}l.t' ed: ;,1 i ' r ' : ' i911114. Subtotal:
Print name: 01/4.1 n0 Date' ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): (p.71
TOTAL PERMIT FEE:. 9
Authorized signature: •
"[
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:\BuildingU'ermi ts\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014 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
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
El 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 •
with OAR 918-309-0040) 552.26 2
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
El Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
El Other: Each additional inspection is 66.25/hr I
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONLY: Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1\Building\Permits\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014
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
11140 SW NORTH DAKOTA ST, TIGARD, OR,
97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00483
Jeff Grove
Violation Summary:
Inspector Contractor