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Permit
v B CITY OF TIGARD ELECTRICAL PERMIT s' COMMUNITY DEVELOPMENT Permit#: ELC2015-00287 T!GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/23/2015 Parcel: 1 S136CB03700 Jurisdiction: Tigard Site address: 11085 SW 83RD AVE Project: Simser/Arnsberg Subdivision: STEVE&HUGHIE'S PLACE Lot: 9 Project Description: (1)branch circuit for bathroom remodel. Contractor: OWNER Owner: SIMSER, SARAH N SIMSER/ARNSBERG ARNSBERG, ERIC 11085 SW 83RD AVE 11085 SW 83RD AVE TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503-913-7630 PHONE: 503-913-7630 FAX: FEES Quantity Description Date Amount 1 crt Branch Circuits wo/Purchase 04/23/2015 $56.18 Specifics: Service or Feeder 1 ea 12%State Surcharge- 04/23/2015 $6.74 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $62.92 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. ATTENT• • •regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0• r through OA' 95 :• -do You may obtain a copy of the rules or direct questions to OUNC by calling 503..2 3�2..1y� ,�o 987or/1�.800.332.2344. Issu>• By: �� 4 Permittee Signature: ,( /[M �'t `n OWNER INSTALLATION ONLY / The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE J(JCJ T /�,yt yt 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 Application NECEIVED fOR OF , I SF ()NIA CI of Tigard Received "/�3 �� (-ID.",Date/By: 7 111 41 Permit No.: fie jev3=60;,,I g 7 13125 SW Hall Blvd.,Tigard,OR 9722 Plan Review Phone: 503.7182439 Fax: 503.598.1 R 2 3 2015 Date/By: Other Permit: T I GA R 17 Inspection Line: 503.639.4175 Date Ready/By: .orris ® See Page 2 for Internet: www.tigard-or.gov �{C�I(TYY(OF TIGARD Notified/Method: Supplemental Information TYPE OF W(JRKNG DIVISt©N PLAN REVIEW ❑New construction ®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 ® 1-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","1-2","1-3", Job no.: Job site address: 11085 SW 83'd Ave IOOHP or more. occupancy. ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP:Tigard,OR 97223 ❑Health-care facilities. ❑Supply voltage for more than ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: Project name: Master Bath ❑Service or feeder 600 amps or more FEE SCHEDULE Cross street/directions to job site:Hall to Pfaffle to 83rd Description I Qty. I Fee. I Total I • 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 Relocate outlet and light switch. Add additional outlet and timer for fan. residential(with above sq.ft.) Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation IS PROPERTY OWNER . ❑ TENANT 200 amps or less 100.70 2 201 amps to 400 amps 133.56 2 Name: Eric Arnsberg Await S 111/SO/ 401 amps to 600 amps 200.34 2 Address: 11085 SW 83'd Ave 601 amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 552.26 2 City/State/ZIP:Tigard,OR 97223 Temporary services or feeders installation,alteration,and/or Phone:(503)913-7630 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,leas rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2 Owner signature' `L 4-4---In 41 I Date: Branch circuits—new,alteration,or extension,per panel ® APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with above service or feeder fee, Business name: each branch circuit 7.42 2 B.Fee for branch circuits withoat i Contact name:Eric Arnsberg service or feeder fee,first 56.18 2 branch circuit Address: 11085 SW 83r1 Ave Each add'I branch circuit 7.42 2 City/State/ZIP:Tigard,OR 97223 Miscellaneous(service or feeder not included) Each manufactured or modular 67.84 2 Phone:(503)913-7630 Fax: :( ) dwelling,service and/or feeder Reconnect only 67.84 2 E-mail:earnsberg@gmail.com Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: 0 W 40 f 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 City/State/ZIP: Additional inspection(1 hr min) 66.25/hr Investigation(1 hr min) 66.25/hr Phone:( ) Fax:( ) 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(/1 hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: 5---(s, /s" Print name: Date: Plan review(25%of permit fee): State surcharge(12%of permit fee): �, j}� Authorized signature: TOTAL PERMIT FEE: 1Q�4 , ,This permit application expires if a permit is not obtained within 180 Print name:Y� Q ? �f�'"cati44- Date4/23//5- days after it has been accepted as complete. /` " Number of inspections allowed per permit. I:\Building\Permit s\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(II/05/COM/WEB 4 , 1 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 Description I Qty. I Fee I Total I • 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 ❑ Burglar Alarm Wind generation systems in excess of 25 kva: 25.01 to 50 kva 301.04 2 ❑ Garage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva(fee in accordance with 552.26 2 ❑ Heating, Ventilation and Air Conditioning OAR 918-309-0040) System* Solar generation systems in excess of 25 kva: 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 charged at an hourly(1 hr min) 66.25/hr Inspections for which no fee is 90.00/hr specifically listed('/z hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system $75.00 Subtotal: (SEE OAR 918-309-0000) Plan review,if required(25%of permit fee): State surcharge(12%of permit fee): Check Type of Work Involved: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 ❑ Audio and Stereo Systems days after it has been accepted as complete. * Number of inspections allowed per permit. ❑ 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 1.\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013