Permit CITY OF TIGARD ELECTRICAL PERMIT
li Permit#: ELC2015 00062
COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/03/2015
TIGARD Parcel: 2S101AB00600
Jurisdiction: Tigard
Site address: 12260 SW 72ND AVE
Project: Kriswandi Subdivision: 1996-024 PARTITION PLAT Lot: 2
Project Description: Replace electrical panel
Contractor: JM3 ELECTRICAL&CONSTRUCTION LLC Owner: GUILLEUX, FEMY
10500 SW CLYDESDALE TERR 11424 SE ORIENT DR
BEAVERTON, OR 97008 BORING, OR 97009
PHONE: 503-961-3537 PHONE:
FAX: 503-718-7268
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 02/03/2015 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 02/03/2015 $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. ATTEN : Oregon . requires you to follow the rules adopted by the Oregon Utility Notification Center. T • : -- -re set forth in OAR
952-001-001 through OAR 952-00 00• Yo •btain a copy of the rules or direct questions to OUNC by calling 03.232.1 . .800. 32.2344.
Issued A. _� _, '��� ..Af,6111gogi / Permittee Signature: ► �.vasc+� [.-
- 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:
COI TRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC'
Aa f Date:
Alto -I F
LICENSE NO. 5 -79 g
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 Applicatiol EC j I M jP I I I R I>I 1 1 t 11 `,1 (1\1 1
City of Tigard Received E'er S oe�(o.
DateB �... Permit#: ��
13125 SW Hall Blvd.,Tigard,OR 9722C Plan Review
. ■ Phone: 503.718.2439 Fax: 503.598.1 0 ,.i 2015 Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: runs: ® See Page 2 for
I I \Ic I Internet: www.tigard-or.gov CITY 1 f 1 t/ A RD Notified/Method: Supplemental Information
TYPE o ■INNG DIVISION. . • . PLAN REVIEW '
❑New construction El Addition/alteration/replacement Please check all that apply(submit 2 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.
11 1-and 2-family dwelling ID Commercial/industrial El Accessory building less to Bound,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family El Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION `/ ❑Emergency system. larger separately derived
Job#: Job site address:
2 Z ,$•L�) Z 4C v e ❑Addition of new motor load of
100HP or more. system.
❑
City/State/ZIP:
- '., r -/ L ❑Six or more residential units. occupancy.
ty L4/�C� l ��2 ❑Recreational vehicle parks.
❑Health-care facilities. P
Suite/bldg./apt.#: Project name: iYg dl'Y`.SLtiefh e%' ['Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross streetJdirectitins to job site: FEE SCHEDULE-,- --
Description I Qty. I Each I Total ( •
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'I 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK • Limited energy,residential
(with above sq.ft.) 75.00 2
���C �%C , , '(./2 r /4.-7e/ 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 / 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:( ) 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: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
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
CONTRACT R Pump or irrigation circle 67.84 2
Business name: 2---/(/ 3 �� / Sign or outline lighting 67.84 •
2
r /e
�' / / Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: /0 57j0 S,4 �' r Q 4 -fi' panel,alteration,or extension. g
City/State/ZIP: ( / ,/7t 7 fr � �v o Each additional inspection over allowable in any of the above
��Q Y e ((( Additional inspection(1 hr min) 66.25/hr
Phone:05) 967_ 31-3 ? /Fax:(C?) 72/9— 22 (8 Investigation(1 hr min) 66.25/hr
Email: <7/113 e7'c/ M C r'/ CQ v Industrial plant(1 hr min) 78.18/hr
•
Inspections for which no fee is 90.00/hr
CC Lic.:l Z��( E ctrical Lic.: C Z/ Suprv.Lic.: �("g S'
specifically listed(%hr min)
//yy�/7 ? ELECFRICAL PERMIT FEES
$uprv.Electrician signature,required: Subtotal: 00. 7 O
Print name:,�C�� ���- Q I Date: 2/3// ❑Plan Review Required(25%of permit fee): r�
State surcharge(12%of permit fee): /e'.-O
Authorized signature:
TOTAL PERMIT FEE: //of• 7 0
This permit application expires if a permit is not obtained within Iso
Print name: Date: days after it has been accepted as complete.
' Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 440.4615T(l1/05/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
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
❑ 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
El Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min) —
Inspections for which no fee is 90.00/hr
specifically listed('h hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit. I
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
El Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
El Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
L\Building\Permi ts'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
12260 SW 72ND AVE, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00062
Jeff Grove
Violation Summary:
Inspector Contractor