Permit q CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit#: ELC2014-00587
T[C;ARO 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/13/2014
Parcel: 1S133DD07700
Jurisdiction: Tigard
Site address: 12761 SW DANBUSH CT
Project: Citibank Subdivision: WOOD HOLLOW Lot: 40
Project Description: Reconnect only.
Contractor: NOT REQUIRED Owner: CITIBANK C/O SELECT PORTFOLIO SERVICING
12761 S DANBUSH CT
TIGARD, OR 97223
PHONE:
PHONE: 360-281-7653
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 10/13/2014 $67.84
Specifics:
1 ea 12%State Surcharge- 10/13/2014 $8.14
Electrical
Type of Use: SF
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 co• or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: A. _ _ _ 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 ApplicatiogECE�rr FOR OFFICE USE ONLY
winiminsimilin
City of Tigard ( Received ( '', Permit No.: _
14 -
• - Plan R
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.5980r DateBy: Other Permit:
T I G AR D Inspection Line: 503.639.4175 8 L U J 4 Date Ready/By: lulls: See Page 2 for
Internet. www.tigard-or.gov Notified/Method: 17 g, Supplemental Information
❑New construction ❑Additio Please check all that apply(submit 2 sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ®Other: where the available fault current
❑Marinas and boatyards.
CATEGORY OF C 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
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
_ ❑Addition of new motor load of ❑"A" "E" "I-2""l-3"
Job no.: Job site address: 12761 S.Danbush Ct.
10011P 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:elect reconnect ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:sw winter lake dr to Danbush Ct Description I Qty. I Fee. 1 Total [ •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision:Village at summer lake park no.3 Lot no.: 116 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.:R2009924
Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 7500 ,
electrical re connect residential(with above sq.ft.) `
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
® PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name:Citibank c/o Select Portfolio Servicing 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 ex tension,per panel
tEl APPLICANT ® CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, -
Business name: Premiere Property Croup each branch circuit 7.42
B.Fee for branch circuits without
Contact name:Ben and Carolyn Campbell service or feeder fee,first 56.18 2
branch circuit
Address: 16505 Se 1st St.suite A,PMB 95 Each add'l branch circuit 7.42 2
City/State/ZIP:Vancouver,WA.98684 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(360)281-7653 Fax::(503)296-5556 dwelling,service and/or feeder
Reconnect only 1 67.84 67.84 2
E-mail:carolynnbenandcarolyn.com , Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: 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(I hr min) 66.25/hr
Phone:( ) Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lie.: specifically listed(%hr mm)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 67.84
Print name: Date: Plan review(25%of permit fee):
State surcharge(12%of permit fee): 8.14
Authorized signature: 6►i' TOTAL PERMIT FEE: 75.98
This permit application expires if a permit is not obtained within 180
Print name: Ben Campbell,assigned agent r SPS Date: 10/7/2014 days after it has been accepted as complete.
" Number of inspections allowed per permit.
I:\Building\Permits\ELC_PennitApp_ELR_ERE.doe Rev 05/21/2013 440-4615T(I 1/05/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
12761 SW DANBUSH CT, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00587
Jeff Grove
Violation Summary:
Inspector Contractor