Permit y CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2014-00656
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/17/2014
Parcel: 2S110DA05000
Jurisdiction: Tigard
Site address: 10512 SW NAEVE ST
Project: JOHNSON Subdivision: ERICKSON HEIGHTS Lot: 11
Project Description: (7)branch circuits for basement remodel.
Contractor: JM3 ELECTRICAL&CONSTRUCTION LLC Owner: JOHNSON, MARK A&MARIE A
10500 SW CLYDESDALE TERR 10512 SW NAEVE ST
BEAVERTON, OR 97008 TIGARD, OR 97224
PHONE: 503-961-3537 PHONE:
FAX: 503-718-7268
FEES
Quantity Description Date Amount
7 crt Branch Circuits wo/Purchase 11/17/2014 $100.70
Specifics: Service or Feeder
1 ea 12%State Surcharge- 11/17/2014 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 - • - -dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You ma obtain a •• of the rules•r direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: -.A -- - 'ttee Signature: t\/1L_"-k _
/'✓
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 I 111; t I l I I I 1 1 .1 1,.1 ,
City of Tigard 7
.
_
13125 SW Hall Blvd.,Tigard OR 9 p�Review trit:14V11-Phone: 503.7182439 Fax: 503.598.1 DatdB Other Pennit Id See Inspection Lille: 503.639.4175 1\10\1 ,^ 2C; Notefied�ethod: C, Supplemental l lafrrmaW.
Internet: www.tigard-or.gov 1
TYPE OF WORK (�.1°. L 1 PLAN REVIEW
❑New construction Addition/alteratio '✓a 'l ' 1 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 esment ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or D Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
Pf 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 lm4tlatioo of 75 KVA or
JOB SITE INFORMATION AND LOCATION D Addition y system. larger"F',"1-2",derived system.
❑Addition of new motor bad of ❑"A°,"E","]-2"."]-3°,
Job no.: Job site address:1D5/2 .S J e e 3 f D Six or residential units 0 Recreational vehicle parics-
Clty/StateJZIP: 224 Heap-terra facilities. 0 Supply voltage for more than
4 r D� 9 4 �� D Flaardous locations. 600 volts nominal-
Suite/bldg./apt.no.: Project name: iii I1(I d D hn fD� ejmit ' D service or feeder 600 amps°r mom.
FEE$CHEDULE
Cross street/directions to job site: Dacrtptim l Qtr. i Fee. 1 Taal 1 •
New residential tdnglc-or multi-family dwelling unit.
- Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 1 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft) 75.00 2
f energy,multi-family 75.00 2
Limited
gel, 5e ri(� l eT ri O�P I). residential(with above sq.R)
/` Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts - 552.26 2
Temporary services or feeders installation,alteration,and/or
City/StateJZIP:
Phone:( ) Fax:( ) 200 amps or less 59.36 I. 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 to 599 amps 168.54 2
Branch circuits-new,alteration,or ex tension,per panel
Owner signature: Date: A.Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B.Fee for branch circuits without
service or feeder fee,first 1 56.18 `5 Q,t V 2
Contact name: M A,IZ k ,)O FF ref S 2, n) branch circuit 0
Each add')branch circuit 1 7.42 41_s-a, 2
Address: / 0511 5 I.J A/4 -.. tit, f f Miscellaneous(service or feeder not included)
City/State/ZIP: C 2 y Each manufactured or modular 67.84 2
I 1 ,','I `l 2 dwelling,service and/or feeder
Phone:( 6-03) S ,� y f . ) 1 i 1.— Fax: :( ) Reconnect only 67.84 2
E-mail: i'1n @.j p rvh n 2(� e c),M A ,1 • (6 '....1
Pump or
outline lighting tinge 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s)or limited-energy
Business name:
panel,alteration,or extension. Page 2 2
h llp Each additional inspection over aBowable in any of the above
Address: �l/37TDy) . � ,r P� U 4^ /ro/a(e C Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
City/StateJZIP: RCci v tC 977"(,g Industrial plant(1 hr min) 78.18/hr
Phone:(5p3) qd7_ ?c37 Fax:(.5-d 3) „e 2 60 Inspections for which no fee is 90.00/hr
Y C� specifically listed('A hr min)
CCB Lic.: /9)5?6 Electrical Lie.: C92/ , Suprv.Lic.: (5;7 ,,I S ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: I Subtotal: �,1�?,"'j0
,,,g4,-----------,
I _ Plan review(25%of permit fee):
Print name: ���y, /-6r-,,,,,,, n Date: /(// J /f State sure ,. t 2%of permit fee): 101.0r
Authorized signature: << "+.•. T FEE: I/0L
This permit appittwr-,- "r rifralfellaarie obtained within OM
Print name: Date:
days er, P'
•_st 1.70. +*�ptese.
• Number of insps
L'''r , -y !,I C-PermaApp toe 07/01 10 440-46t5T4 I I/09COMM'EB
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
10512 SW NAEVE ST, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00656
Jeff Grove
Violation Summary:
Inspector Contractor