Permit CITY OF TIGARD ELECTRICAL PERMIT
"1 le COMMUNITY DEVELOPMENT Permit#: ELC2015 00304
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/29/2015
Parcel: 2S110BD08100
Jurisdiction: Tigard
Site address: 14822 SW 117TH PL
Project: Eisenbach Subdivision: 1995-015 PARTITION PLAT Lot: 3
Project Description: (2)branch circuits for master bath remodel.
Contractor: SAM HARDING INC Owner: EISENBACH, CHARLES R&SHERRY B
19988 SW GASSNER RD 14822 SW 117TH PL
BEAVERTON, OR 97007 TIGARD,OR 97224
PHONE: 503-780-6224 PHONE:
FAX: 503-356-9729
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 04/29/2015 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 04/29/2015 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports(Conditions)
permit is iss 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 ith 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, I- r=•uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 t rough OAR •• -001-0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:1' 411"! Permittee Signature: edf
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' D �. '" 9/5—Date: 4�
LICENSE NO. 677 j 5
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 COVE
FOR OFFICE USE ONLY
City of Tigard n C CEIV G Received ,®i
z — DateB Permit#: L�t C[ J c y,L,
. i 13125 SW Hall Blvd.,Tigard,OR 9 Plan Review
• Phone: 503.718.2439 Fax: 503.598.1960 q 9 2015 Date/By:
Related Permit N:
Inspection Line: 503.639.4175 NPR 2+ Ready Date/By: Ads: ® See Page 2 for
, \I.I, Internet: www.tigard-or.gov iGaRp Notified/Method: Supplemental Information
❑New construction Addition/alte acement Please check all that apply(submit/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.
exceeds 10,000 amps at 150 volts or ❑Floating buildings.
1-and 2-family dwelling ❑Commercial/industrial ID Accessory building less to ground or exceeds 14,000 0 Commercial-use agricultural
❑Multi-family ❑Master builder ❑Other: ❑amps pump. ❑Installation s um all other installations. buildings.
tallation of 150 KVA or
I ❑Emergency system. larger separately derived
Job#: Job site address: f 42� 0 ` L ❑Addition of new motor load of system.
1 OOHP or more. ❑"A" "E",•`1-2" "1-3°
City/State/ZIP: ��--{--�/ -777A_ ❑Six or more residential units. occupancy.
ty I C7 fQ2 I O ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: .F..( C ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: , ,
Description Qty. Each Total •
New residential single-or multi-family dwelling unit.
Subdivision: I 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
Limited energy,residential 75.00 2
C2) b A ech e -t-_ /- (with above sq.l.)
(��' ,t-(�JJU/�J ��- Limited energy,multi-family
p residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 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:( ) I 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
Branch circuits–new,alteration,or extension, er 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 ,
Address: service or feeder fee,first 56.l8 52 /< 2
branch circuit
City/State/ZIP: Each add'l branch circuit / 7.42 1 y9-''2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: i � rr . ® C�. � � �� panel,alteration,or extension. g
City/State/ZIP: ' 1 G��,�y, Each additional inspection over allowable in any of the above
\�tz_tr �.) I 2- ` c 7 Additional inspection(1 hr min) 66.25/hr
Phone:(6g3) 7 0 __62_2_4 Fax:(r ) 9 7z,7 Investigation(1 hr min) 66.25/hr
Industrial plant(1 hr min) 78.18/hr
Email: '2,0„(,/tika.b/, -r / U:- -G� cL-w1+n1_. '
�^�L Inspections for which no fee is 90.00/hr
CCB Lic.: U )4!s, Electrical Lic.: ' C Suprv.Lic.: 738 specifically listed %:hr min
Suprv.Electrician signature,required: 1( , ��///� � Subtotal: 5.
Print name: TOM �Q /ic16.7_ Date: c_- ZC� ,6 ❑Plan Review Required(25%of permit fee): —-
State surcharge(12%of permit fee): 7 ag
Authorized signatt ` //', TOTAL PERMIT FEE: CV ,a'5
This permit application expires if a permit is not obtained within 180
Print name: o. A 1 l(�l,, Date: 4 el, 75 days after it has been accepted as complete.
a 1 • Number of inspections allowed per permit.
I:\BuildinglPermitaELC_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 { Qty. I Each I 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:
n 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 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 over25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allow able 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(A hr min)
COMMERCIAL WORK ONLY: � ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00
Subtotal le perm t 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
14822 SW 117TH PL, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00304
David Young
Correction done.
Violation Summary:
Inspector Contractor
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
14822 SW 117TH PL, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
FAIL
ELC2015-00304
David Young
Finish under cabinet lighting.
Violation Summary:
Inspector Contractor