Permit CITY OF TIGARD ELECTRICAL PERMIT
''1 s •• COMMUNITY DEVELOPMENT Permit#: ELC2015-00043
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/22/2015
Parcel: 1 S134BD08200
Jurisdiction: Tigard
Site address: 11618 SW PENN CT
Project: WELL Subdivision: PENN LAWN ESTATES Lot: 10
Project Description: Bathroom remodel with(1)sub panel and(5)branch circuits.
Contractor: R& D ELECTRIC INC Owner: WELL, LARRY W&DOROTHY J
PO BOX 868 11618 SW PENN CT
MULINO, OR 97042 TIGARD, OR 97223
PHONE: 503-679-7987 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 01/22/2015 $100.70
Specifics: amps or less
5 crt Branch Circuits w/Purchase 01/22/2015 $37.10
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 01/22/2015 $16.54
Electrical
Type of Const:
Occupancy Grp:
Total $154.34
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 Cen r. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obt �j-ettbe rules or direct questions to OUNC by calling 503. 2.198 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.
10 Electrical Permit Application N I OI; I I l I I( I I 'l ()NI 1
Received
City of Tigard Date/By: j 1 S /1jT Perm": 5l.C.2-D 15"-14 b& 3
14
• 13125 SW Hall Blvd.,Tigard,OR 97223 ``11 2�1� plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 �,v r� Date/By: Related Permit#:
Inspection Line: 503.639.4175 ruAgV Ready Date/By: Juris. 0 See Page 2 for
l 1 I 1 Internet: www.ti azd or. ov °T pff t:.„ tified/Method: Supplemental Information
TYPE OF WO 1(i V PLAN REVIEW
❑New construction la-Addition/alteratiNigacement Please check all that apply(submit 1 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.
and 2-family dwelling less to ground,or exceeds 14,000 ❑Commercial-use agricultural
y g ❑Commercial/industrial CI 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
❑Addition of new motor load of system.
Job#: Job site address: ( ( 6 t 3 S 'eiv„1/4.) L`G 100HP or more. ❑"A","E","l-2","l-3",
City/State/ZIP: ❑Six or more residential units. occupancy.
tY t�(� -7 Z ❑Recreational vehicle parks.
ici-- `tom... � l 7- � 0 facilities. P
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.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'1 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
■ f 1 . I►411. Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less I 100.70 )U O
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:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,altera-tion,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 I
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 1 ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,pe-r panel
A.Fee for branch circuits with
Business name: above service or feeder fee, /�
�q/I'!A Gt.S each branch circuit S 7.42 7, I`� 2
Contact name: B.Fee for branch circuits without g
service or feeder fee,first 2
Address: 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
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: \ 9r ,. n !` LU C_ Sign or outline lighting 67.84 2
Address: p Signal circuit(s)or limited-energy ❑ See Page 2 2
w 'U D panel,alteration,or extension. -
C� Each additional inspection over allowable in any of the above
City/State/ZIP: ���`�1` ,C J (� l 2 Additional inspection(1 hr min) 66.25/hr
Phone:(x,3 )�7C{ . —7�gW 7 �Faax:( ) Investigation(1 hr min) 66.25/hr
Email: I -/? ( 1 i/i \ 1��spectiol s plant r(1 hr min) 78.18/hr
/ ` spections for which no fee is 90.00/hr
`�z sQ 14 specifically listed(V2 hr min)
CCB Lic.: J l Electrical Lic. � 3q Suprv.Lic. 5�,
j 1 ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: �t`�'LC_7`� Subtotal: /. -7. ,
Print named�� �. � Date: '_�Z., ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): (9,S`f
Authorized signature: TOTAL PERMIT FEE: ./�y / -
This permit application expires if a permit is not o.tained within 180
Print name: Date: days after it has been accepted as complete.
' Number of inspections allowed per permit.
1:1Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 440-46151(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:
El Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
El Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
El Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over25 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
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(/2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): I
' Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
C\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 Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11618 SW PENN CT, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00043
Jeff Grove
Violation Summary:
Inspector Contractor
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
11618 SW PENN CT, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00043
Jeff Grove
Violation Summary:
Inspector Contractor