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Permit n CITY OF TIGARD ELECTRICAL PERMIT ' 3 COMMUNITY DEVELOPMENT Permit#: ELC2015-00204 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/01/2015 Parcel: 2S103DC06400 Jurisdiction: Tigard Site address: 11220 SW FAIRHAVEN ST Project: Wolf Subdivision: EXODUS Lot: 5 Project Description: Convert existing bedroom into master suite bath,(4)branch circuits. Contractor: OWNER Owner: WOLF, DEAN 0 DEAN WOLF MATAYA, LINDA 11220 SW FAIRHAVEN ST 11220 SW FAIRHAVEN ST TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503-267-8840 PHONE: 503 267-8840 FAX: FEES Quantity Description Date Amount 4 crt Branch Circuits wo/Purchase 04/01/2015 $78.44 Specifics: Service or Feeder 1 ea 12%State Surcharge- 04/01/2015 $9.41 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $87.85 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 accordanc- 'th approved plans. This permit will expire if work is not started within 180 days of issuan• , • if work is suspended for more the 180 days. ATTENTION: Oregon law ...res you to follow the rules adopted by the Oregon Utility Notification Cente Those rules are set forth in O•R 952 01-0010 thr•ugh OAR 952-•• -0090, may obtain a c py of the rules or direct questions to OUNC by calling 503.2 .1987 or 1.800.332.2344. I sued By: 1 <� ,� Permittee Signature: GL) , / OWNER INSTALLATION ONLY ' The installation is being made on property I own wh' h is not intended for e leas or re OWNER'S SIGNATURE ` eLy" 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 PermitApplica>WCEIVED IOIZO1F1( I. 1 til O\I.1 IN City of Tigard PR 1 2015 Received /e Permit#: E ■ 13125 SW Hall Blvd.,Tigard,OR 97 3 Plan R : �I Dd- ■ Phone: 503.718.2439 Fax: 50 . Plan Review�ew Related Permit#: Inspection Line: 503.639.417 �F TIGARD Ready Date/By: Juris: ® See Page 2 for I I t 'K n Internet: www.tigard-or.gov BiUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑New construction fij Addition/alteration/replacement Please check all that apply(submit,<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. 'KT_and 2-family dwelling ❑Commercial/industrial El Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural 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 Job#: Job site address: ❑Addition of new motor load of system. I i 2�0 5 W Fa t r61 Q U e N s-t 100HP or more. ❑"A" "E" "1-2" "l-3„ City/State/ZIP: 3 ❑Six or more residential units. occupancy. TQr Gl f 97 2 3 ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: �JJ 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: E d o s Lot#: S Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'1500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK - Limited energy,residential 1 (with above sq.ft.) 75.00 2 *are,,), ( r) i'-s r`l4A^ I Ct►rzw:`f TA' A *s/ ditf) Limited energy,muhi-family, 75.00 2 residential(with above sq.ft.) � f ' ' Renewable Energy _ ❑ See Page 2 tiff PROPERTY I RTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: 0 ....C2R Y\ J o 1 f 200 amps or less 100.70 2 Address: 5 a VAC= y a lv o ye 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 -r Temporary services or feeders installation,alteration,and/or Email: d ea n a w c I F e_. h G r vv.a(k , co tr 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,le e, ent,or exchange,acc ding to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 eOwner signature: ea.... w Date: 41—t — /5 401 amps to 599 amps 168.54 2 ❑ APPLICANT ❑ 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 service or feeder fee,first 56.18 2 Address: branch circuit City/State/ZIP: Each add'l branch circuit _3 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: Ob0 6/!--- Sign or outline lighting 67.84 , 2 Signal circuit(s)or limited-energy ❑ See Page 2 2 Address: panel,alteration,or extension. Each additional inspection over allowable in any of the above City/State/ZIP: Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(1 hr min) 66.25/hr Email: Industrial plant(1 hr min) 78.18/hr - Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(%hr min) --- ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: 7/.p 7$44, Print name: Date: ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): _ 5-P 14/ Authorized signatuAi -� ,. tit TOTAL PERMIT FEE: �,Sy — This permit application expires if a permit is not ob ned within 180 Print name: / e W d Date: r./_ days after it has been accepted as complete. De oh 1'F Y r • Number of inspections allowed per permit. d I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 440-461S1(1I/05/COM/WEB c6 7- Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE • Fee for all residential systems combined: $75.00 IsQty. Each I Tog Renewable s I y Renewaa ble 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 ❑ Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 ❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 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(%l hr min) COMMERCIAL WORK ONLY•• ELECTRICAL PERMIT FEES(Enter on Page 1): Subtotal Fee for each commercial system: $75.00 • Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I-\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants,exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or ' I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. Dew wc) If Print Name of Permit Applicant �� L � — (S Signature of Permit Applicant Date Permit#: e11'jt/ti-00o,C,l/Hfc'ic`/5--00 PI17/AY5=an/el •T otr ` "'d i/ffn✓6J , Address: � �•-��"„'."�s;� f C2- i7aa Issued 10-a cskoi,Date: 9/,fr. 1-1V This Copy for Permit Offices 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 11220 SW FAIRHAVEN ST, TIGARD, OR, 97223 Residential - Electrical 199 Electrical ﬁnal PASS - No C of O ELC2015-00204 David Young Violation Summary: Inspector Contractor