Permit CITY OF TIGARD ELECTRICAL PERMIT
•N
COMMUNITY DEVELOPMENT Permit#: ELC2015-00310
T V AR 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/30/2015
Parcel: 1 S136CA90000
Jurisdiction: Tigard
Site address: 10900 SW 76TH PL 56
Project: U.S.DEPARTMENT OF HOUSING&URBAN DEVELC Subdivision:GARD WOODS,A CONDO COMMUNI1 Lot:
Project Description: Reconnect only.
Contractor: Owner: U.S. DEPARTMENT OF HOUSING&URBAN DEV
451 7TH STREET SW
WASHINGTON, D.C. 20002
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 04/30/2015 $67.84
Specifics:
1 ea 12%State Surcharge- 04/30/2015 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports(Conditions)
This p is issued s t to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be ne in accordance with •proved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
d s. ATTENTION: Oregon I- •• -s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
2-001-0010 through OAR 95 r 1-0090. ou ay obtain a copy of the rules or direct questions to OUNC by calling 5 . 2.1987 or 1.800.332.2344.
sued By: '41°./ '.d _ Permittee Signature:
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.
T,,.
./ _.`, Electrical Permit Application Project#.
�y • Washington County,155 N.1"AV,Suite 350,MS 12,Hillsboro,OR 97124,
• Phone: 503-846-3470,Fax:503-846-3993/lutbldg @co.washington.or.us Permit# 0201 S-cX:3i c
Inspection Requests:503-846-3699/www.co.washington.or.us/piro
TYPE OF WORK PLAN REVIEW
❑New construction ❑Addition/alteration/replacement ®Other: Please check all that apply:
RECEIVE
orServmeicree or feeder 400 amps❑ Hazardous locations re
CATEGORY OF CONSTRUCTION fault current xcteedsail able❑ Sesviceor feeder 600 amps ormote
❑ Building over three stories
E 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building 10,000 amps at 150 volts or❑ Marinas and boatyards
less to ground,or exceeds
❑Multi-family ❑Master builder ❑Other: ' 14,000 amps for all other ❑ Floating buildings
JOB SITE INFORMATION AND LOCATION APR 3 0 �O ❑ Commercial-use agricultural
installations.
Fire pump buildings
y Job no.: Job address: 10900 SW 76th PI CHI'OF l l(,AKg Emergency system ❑ Installation of 150 KVA or larger
separately derived
City/State/ZIP: Tigard, OR 97223 BUILDING DIVIStIVtdditionof new motor ❑ „ ,,,/-2,,•Roccupancy
\ load of 100HP or more
Suite/bldg./apt.no.: 56 Project name: ❑ Six or more residential units ❑ Recreational vehicle parks
❑ Health-care facilities ❑ Supply voltage for more than
600 volts nominal
Cross street/directions to job site: SW Spruce St
SW Spruce St Description FEE SCHEDULE
ruce
p Descption 1 Qty. I Fee I Total I *
NSubdivision: Lot no.: ResideataI single-or multi-family dwelling nit
Includes attached garage. _
Tax map/parcel no.: R2100858 1,000 sq.ft.or less 167.00 4
tDESCRIPTION OF WORK Ea.add'I 500 sq.ft.or portion 47.00
Limited energy,residential 107.00 2
Qr/ (with above sq.ft.)
Limited energy,multi-family 107.00
residential(with above sq.ft.) 2
PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
200 amps or less 107.00 2
Name: H u'3) 201 amps to 400 amps 161.00 2
k.Address: q 5 l -74,, 5i- s 40I amps to 600 amps 214.00 2
`.1- 601 amps to 1,000 amps 321.00 2
City/State/ZIP: �1/°r .�� 4 L / Over 1,000 amps or volts 642.00 2
Phone:(' 6L.) 7e g l, 4 tL Fax:( ) Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on residential or farm property owned by me or a member of 200 amps or less 107.00 2
my immediate family. This property is not intended for sale,exchange or rent.(ORS 479.540(l)and 479.560(1). 201 amps to 400 amps 161.00 2
Owner signature: Date: 401 amps to 599 amps 214.00 2 N ® APPLICANT 1 ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
" A.Fee for branch circuits with
Business name:Home Buyer above service or feeder fee, 9.50
each branch circuit 2
Contact name: `� B.Fee for branch circuits It
�� 14.i (��/ 6.-7)- Q without service or feeder 107.00
Address: S c,5 QT /�� ! fee,first branch circuit 2
Each add'l branch circuit 9.50
) cr 2, ZZ 3
t d 1 1 J MisceWneous(service or feeder not included)
one:(5'p 3) QG O 7g5 L Fax:( ) Each manufactured or modular 113.50 2
ijty/State/ZIP:
dwelling,service,and/or feeder
E• -mail: Reconnect only 1 -f9 �y 6?.i511 1
ZCONTRACTOR Pump or irrigation circle 107.00 2
Business name: Sign or outline lighting 107.00 2
Signal circuit(s)or limited-
energy energy panel,alteration,or 107.00
extension.Describe:
City/State/ZIP: 2
P• hone:( ) Fax:( ) Each additional inspection over allowabk in any of the above
Per inspection 107.00
E• -mail: CCB lic.no.: Investigation fee(See compliance)
Electrical lic.no.: City or metro lic.: Other:
ELECTRICAL PERMIT FEES
Supervising electrician
signature,required: Subtotal (v 7- (
Print name: Date:
Plan review(25%of permit fee)
Authorized State surcharge(12%of permit fee) %-. i/
signature: TOTAL PERMIT FEE 175;q$
This permit application expires if a permit is not obtained
Print name: Date: within 180 days after it has been accepted as complete
-
•Number of inspections allowed per permit. Revision 6/13