Permit U CITY OF TIGARD ELECTRICAL PERMIT
II . COMMUNITY DEVELOPMENT Permit#: ELC2015-00226
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/08/2015
Parcel: 2S 103AA01908
Jurisdiction: Tigard
Site address: 12355 SW 106TH DR
Project: Brugger Subdivision: COTTONWOOD PLACE Lot: 11
Project Description: Replace panel
Contractor: COWGER ELECTRIC LLC Owner: BRUGGER,JUDITH C&JOHN A
3418 KNOLL DR 12355 SW 106TH DR
NEWBERG, OR 97132 TIGARD,OR 97223
PHONE: 971-222-6650 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 04/08/2015 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 04/08/2015 $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. ATT ION: Oreg.• law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001- 10 through OAR 95 !• -..9 You may obtain a copy of the rules or direct questions to OUNC by calli • .• . 32.1987 or 1.800.33 .2344.
Issue B IL / Cam! y u �t/ a j il�'�
y� —. 4 Permittee Si nat_.` +_ .. /ca d
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' 1rJ' 1(6i-J Date: If f/5
LICENSE NO. 5c90 E J
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 FOR OFFICE USE ONLY
City of Tigard RECEIVED Received ,
Permit No.:
- Y g DateB : �/ � /5 �'�/5
II
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960A P R 8 2015 Date/B Other Permit:
TI G A R U Inspection Line: 503.639.4175 Date Ready/By: furls: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
g z r^rb rte+ r-¢at (!�! ar
TYPE OF vol .. „,,,14.7:-!!::::::11:''Z:,.... W
❑New construction 1E J Addition/alteration/replacement 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 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
al-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
❑Emergency system. larger separately derived system.
b7'E 1 ` 1 1 !t . it 7 -
,;- , : ! ' ��. ❑Addition of new motor load of ❑«A,>«E„ «t_2»«1.3>,
Job no.: Job site address: 55 16(p-1-� 100HP or more.
occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP -5Q O� ❑Health-care facilities.
❑Hazardous locations. ❑Supply voltage for more than
600 volts nominal.
Suite/bldg./apt.no.: Project name: e.u-{a a f& ❑Service or feeder 600 amps or more.
sir ' :`, "AEDULE
Cross street/directions to job site: Descripaen Qty.
Fee.
Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq ft.)
%It wabl , e 2
Services or feeders installation,alteration,and/or relocation
0 PROPERTY OWNER ❑ TENANT 200 amps or less I 100.70 i 00 ,-7 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 1
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, r panel
, �
❑ APPLICANT ❑", 1 �'�� , �� �� A.Fee for branch circuits with
""' — ” above service or feeder fee,
Business name: r' each branch circuit
7.42 2
`�8 Q� I r 1 L �"�'�- B.Fee for branch circuits without
Contact name: J tSin ex A e service or feeder fee,first 56.18 2
branch circuit
Address: 31A1% �ro 1\ p r Each add'I branch circuit 7.42 2
City/State/ZIP: .('�`''� Miscellaneous(service or feeder not included)
\Ve..,,,.1\3egf3 G "I l 13Z_ Each manufactured or modular 67.84 2
Phone:(C'cl 1 ) Ilk (1.4 Fax::( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: r N c"O �, Q OW G[IR 5 Lec- g t e, Co T\ Pump or irrigation circle 67.84 2
CONTRACTOR . -,' »` Sign or outline lighting 67.84 2
Business name: Signal circuit(s)or limited-energy See
CAN) le- E I p c-I r�e L.L.` panel,alteration,or extension. Page 2 2
Address: 34 I% K e.k\ f Each additional inspection over allowable in any of the above
1 Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: Ne,Ujo.trq Ci0..._ q7 13-2_ Investigation(1 hr min) 66.25/hr
Phone:(T)) ) ).). (656 Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: I CI4S2,t-t�6 Electrical Lic.: C-edei Suprv.Lic.: 5aoc5 s cifcall listed 'h hr min
a ;ti., ` ° FEES
Suprv.Electrician signature,required:
f/ Subtotal: j 00,-i(\
Print name: Y e 1-7-14 o 0 g l� Date: 3/3,/f 5 Plan review(25%of permit fee):
t\ go State surcharge(12%of permit fee): #Z .
Authorized signature: tf TOTAL PERMIT FEE: //2 lV
/ OVA, This permit application expires if a permit is not obtained within 180
Print name: tJds// A Date: ' days after it has been accepted as complete.
* Number of inspections allowed per permit.
t:\Build ing\Permits\ELC_PermitApp ELR ERE.doc Rev 05/21/2013 4404615T(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
12355 SW 106TH DR, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00226
Jeff Grove
Violation Summary:
Inspector Contractor