Permit 1,1 If CITY OF TIGARD ELECTRICAL PERMIT
_ COMMUNITY DEVELOPMENT Perm flit: ELC2015-00021
Ti G A R O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/15/2015
Parcel: 1S125DB04600
Jurisdiction: Tigard
Site address: 7190 SW TAYLORS FERRY RD
Project: Pete Anderson Realty Subdivision: SHADY DELL NO.2 Lot: 20
Project Description: Reconnect only.
Contractor: Owner: FHLMC
10610 SE WASHINGTON ST
PORTLAND, OR 97216
PHONE:
PHONE: 503-256-9723
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 01/15/2015 $67.84
Specifics:
1 ea 12%State Surcharge- 01/15/2015 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
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 an - or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow th> . = -•••ted by the Oregon Utility N•''cation Ce er. Those rules . set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy- the rules or•'ect questions to OUNC by ca mg 503.232.1•= -r 1.800.3 .
Issued Per •.nature: /
4111railb -
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 Appli11ikEIVEP FOR OE t It E. USE O\ .1
Received
- City of Tigard Plan R : 1 ,_frA. 1'emm No.: ><✓a� 15 . __ "_
13125 SW Flail Blvd.,Tigard,024 5 2015 Plan Revie
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
TIGARD Inspection Line: 503.639.4175`,rY Of 11r ARD Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.go�vtkA I �U( lI ceI� Notified/Method: Supplemental Information
i vi,lioN PLAN REVIEW
❑New construction ❑+Addition/alteration/replacement Please check all that apply(submit/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 CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
® I-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",
I OOHP or more. occupancy.
Job no.: Job site address:7190 SW Taylors Ferry Rd 0 vehicle
❑Six or more residential units. parks.
City/State/ZIP:Tigard,OR 97223 ❑Health-care facilities ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: l Project name:PeteAndersonRealty ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. 1 Fen 1 TouJ f •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: f Lot no.: 1,000 sq.tt.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.:R0231289
Limited energy,residential
;x: ,-____ .,..:. . i DESCRIPTION OF WORK Aiiiikain ( sq ft.) 75.00 2
with above ft.
Limited energy,multi-family 7500 2
Electricity Re-Connect Inspection residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER 200 amps or less 100.70 2
❑ TENANT
201 amps to 400 amps 133.56 2
Name: FHLMC 401 amps to 600 amps 200.34
2
Address: 10610 SE Washington St. 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:Portland,OR 97216 Temporary services or feeders installation,alteration,and/or
Phone:(503)256-9723 1 Fax:( ) relocation
200 amps or less 59.36 I
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,per panel _
® APPLI t ® CONTACT PERSON A Fee for branch circuits with
above service or feeder fee,
742 2
Business name: Pete Anderson Realty Relo each branch circuit
B.Fee for branch circuits without
Contact name:Jason A Lee service or feeder fee,first 56.18 2
branch circuit
Address: 10610 SE Washington St. Each add'I branch circuit 7.42 2
City/State/ZIP: Portland,OR 97216 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(503)256-9723 I Fax: :( ) dwelling,service and/or feeder
Reconnect only / 67.84 �? 2
E-mail:jason @peteandersonrealty.com Pump or irrigation circle 67.84 2
r, CONTRA
. 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(I hr min) 66.25/hr
City/State/ZIP:
Investigation(I hr min) 66.25/hr
Phone:( ) Fax:( ) Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv. Lic.: specifically listed(V2 hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal: &7. K'"
Print name: Date:
Plan review(25%of permit fee): -----
( y� State surcharge(12%of permit fee): �./V
Authorized signature:-- i�'2� r ' TOTAL PERMIT FEE: 75. `I c(
/ This permit application expires if a permit is not obtained within 180
Print name: JA c sh a tee Date: it// , /s
days after it has been accepted as complete.
Number of inspections allowed per permit
1.\Building\Permits\ELC_PermitApp_ELR_ERE doe 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
7190 SW TAYLORS FERRY RD, TIGARD, OR,
97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00021
Jeff Grove
Violation Summary:
Inspector Contractor