Permit ! q CITY OF TIGARD ELECTRICAL PERMIT
;F1 s COMMUNITY DEVELOPMENT Permit#: ELC201500268
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/21/2015
Parcel: 1S 135CA90217
Jurisdiction: Tigard
Site address: 11044 SW GREENBURG RD 217
Project: WINSLOW Subdivision: ASH CREEK PARK CONDO Lot: 217
Project Description: Replacing existing panel.
Contractor: ABS ELECTRIC LLC Owner: WINSLOW, JUDITH H
752 DIVISION ST 11044 SW GREENBURG RD#217
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503-888-7676 PHONE:
FAX: 503-257-6168
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 04/21/2015 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 04/21/2015 $12.08
Type of Use: MF 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. Specia Codes and all oth= appli•-ble law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of suance, or if work s sus•- dad for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifica • Center. Thos rules re set forth in OAR
952-001-0010 through OAR 952-001-0090. You ma obtain a copy direct questions to OUNC by calling 503 .1987 or 1.800.3 2.2344.
•mow;
Issued By: -_ _ Permittee Signature: aOf .,A
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.
Cali 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 C��Nt 1.01,z 1.01,z Ol 1 1( I I ti (1
t \1 1
Received
City of Tigard DateB : .l l
114
13125 SW Hall Blvd.,Tigard,OR 97223 ��� �� ��
4).)\.1- 16 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Q� k) Date/8 : Related Permit#:
Inspection Line: 503.639.4175 P 1V�� • Ready Date/By: la See Page 2 for
I I t,;\P.D Internet: www.tigard-or.gov �� t D��•`CAVI Notified/Method: Supplemental Information
E OF wOR�G NNG PLAN REVIEW
['New construction Addition/alteratit�l�ement 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.
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
FMulti-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: a�� /� � , ❑100H Addition of new motor load of system.
� /� t 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: ,Q' ❑Six or more residential units. occupancy.
1 .JU _ ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#0,1,J(�1
t ❑Service or feeder 600 amps or more. 600 volts nominal.Project name: 0 Hazardous locations. 0 Supply voltage for more than
Cross street/directions to job site: FEE SCHEDULE .
Description I Qty. 1 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'I 500 sq.ft.or portion 33.92 I
DESCRIPTION O WORJ Limited energy,residential
�1 /J y► (with above sq.ft.) 75.00 2
/,,e fl 6,4 ail,A z!0c-4i Limited energy,multi-family
�n/J A residential(with above sq.ft.)
75.00 2
V l� Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less / 100.70 MI 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: C � �''f- &)� above service or feeder fee,
(� , each branch circuit 7.42 2
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 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
ONCTOR Pump or irrigation circle 67.84 2
Business name: A eg S EI c I.-LC Sign or outline lighting 67.84 _ 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: -75-2„ i i- (.5 j 5 panel,alteration,or extension.
�p Each additional inspection over allowable in any of the above
City/State/ZIP: Qt/..Q Qyl (e one. X7 5
��� 7� Additional inspection(I hr min) 66.25/hr
Phone:50� -76 Fax:( ) Investigation(1 hr min) 66.25/hr
Email: J Industrial plant(1 hr min) 78.18/hr
p Inspections for which no fee is 90.00/hr
CCB Lic.: is t 874 Electrical Lic.: 2-V I al k Suprv.Lic.:3� 5 specifically listed(%hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: i k r/_ 1V Subtotal: / 70
Print name: L6,:og 6 Ise 1-1 Date: 14 I Z I) 16'
. ' ❑Plan Review Required(25%of permit fee): —
State surcharge(12%of permit fee): LL,
Authorized signature: TOTAL PERMIT FEE: ,/a,, 7g
794 4 This permit application expires if a permit is not o tained within 180
Print name: 94 04 V-i Y'I 5 e - I4C Date: Ul Z// ) days after it has been accepted as complete.
/f • Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 440-4615T(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 1 Qty. 1 Each 1 Total 1 •
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
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
n 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
charged at an hourly(I 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):
• 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
1:\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
11044 SW GREENBURG RD 217, TIGARD, OR,
97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00268
Jeff Grove
Violation Summary:
Inspector Contractor