Permit CITY OF TIGARD ELECTRICAL PERMIT
_ ' COMMUNITY DEVELOPMENT Permit#: ELC2015-00259
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/20/2015
Parcel: 25111 DB12400
Jurisdiction: Tigard
Site address: 15275 SW 94TH AVE
Project: Vankleek Subdivision: SUMMERFIELD NO.12 Lot: 651
Project Description: Replace 200 amp panel.
Contractor: FUZION ELECTRIC LLC Owner: VANKLEEK FAMILY TRUST
1335 SW 197TH AVE 15275 SW 94TH AVE
ALOHA, OR 97006 TIGARD, OR 97224
PHONE: 503-528-6033 PHONE
FAX: 866-284-0482
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 04/20/2015 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 04/20/2015 $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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifi.<ion Center. Those// rules are set forth in OAR
952-001-0010 throu '01- 90. You may obtain a copy of the rules or direct questions to OUNC by ca ing 5r•.232.1987 or 1.8r 4.3,82.2344.
Issued By7 _ J Permittee Signature: �. y��/►`� —
\ r
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.
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 RECEIVE. I OIt ()I I It I I tit 11\I 1
ate/Bey e� * • � 0%s—Daffy'
City of Tigard Date/By: �,� Permit#LC
14 • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revi Related Permit#:
= Phone: 503.718.2439 Fax: 503.598.1960 APR 16 2015 Plan Re:
Inspection Line: 503.639.4175 Ready DateBy: Juris: HI See Page 2 for
I I c'n R l) Internet: www.tigard-or.gov CITY OF fi(A R;Notified/Method: 776' Supplemental Information
TYPE OF WOA D�SION PLAN REVIEW
❑New construction .Addition/alteration/replacement 11 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.
-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
jAll.
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
15 L7 5 5• ` 61 / /,�,. ❑Addition of new motor load of system.
Job#: Job site address: NJ "] (•� 100HP or more. ❑"A",`E^, 1-2", 1-3",
Ci /State/ZIP: ❑Six or more residential units. occupancy.
ty �✓ ❑Recreational vehicle arks.
I ❑Health-care facilities. P
Suite/bldg./apt.#: 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: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
t e r� a.e Ci e c - (�WwQ ` (with above sq.ft.) 75.00 2
{� f Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER ❑ TENAN Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less I 100.70 /oo.7o 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 01.04 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 ❑ 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 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
Email: dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR - Pump or irrigation circle 67.84 2
Business name: l/ X21 W" .4 l'G4yi C. Signor outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 13`5 5 5 c...i I q 741 A� panel,alteration,or extension. ❑ See Pa g e 2 2
City/State/ZIP: A (d Lo,. , 6x -Q 1 "7 0 d 3 Each additional inspection over allowable in any of the above
//', ^� Additional inspection(1 hr min) 66.25/hr
Phone:(5 52 V' ( 3 ) Fax:( ) Investigation(1 hr min) 66.25/hr
Email: bvew&( t,ZIo,4 e(e c�ri,.cm+-� Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
specifically listed(%2 hr min)
CCB Lic.: g�7 5 Electrical Lic.: CS� I Suprv.Lic.: 55zS ELECTRICAL PERMIT FEES
Suprv.Electrician sign/at�ure,reTquired: _ Subtotal: /O. 70
Print name: ,7,4 TOO t KS I Date: q—ZO"1.r� ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): .3 4 r/.?.t 7
41, Al ,Authorized signature: . !A
TOTAL PERMIT FEE: r
This permit application expires if a permit is not obtained within 180-
Print name: d�— I 'sV Y� Date: -20- /6 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 440-46151(11/05/COM/WEB //t2 1 71
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 kvaorless 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
Fl 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 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(Az hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 • allowed al(Enter on Page 1):
y • 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
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
15275 SW 94TH AVE, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00259
Jeff Grove
Violation Summary:
Inspector Contractor