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Permit � n CITY OF TIGARD ELECTRICAL PERMIT I ' COMMUNITY DEVELOPMENT Permit#: ELC2015 00390 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/20/2015 Parcel: 2S103AB03700 Jurisdiction: Tigard Site address: 12079 SW 113TH PL Project: HARRIS Subdivision: MEADOWGLADE Lot: 6 Project Description: A/C installation. Placement of NC unit must comply with manufacturer's clearance requirements. Contractor: OWNER Owner: HARRIS, CHADWICK STEPHEN CHAD HARRIS 12079 SW 113TH PL 12079 SW 113TH PL TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503-703-2178 PHONE: FAX: FEES Quantity Description Date Amount 1 crt Branch Circuits wo/Purchase 05/20/2015 $56.18 Specifics: Service or Feeder 1 ea 12%State Surcharge- 05/20/2015 $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 •rk is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cent= . h••-- rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of e rules or ect questions to OUNC by calling 50 i '.332.2344. Issued By: may - - =�_ e • -• 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. Electrical Permit Application 1 t)1t 01 l It I I "Si t l\l l City o f g Tigard Received City Date/B : 5— ,,/15— : _ ., • r. 74 • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ■ Related Permit#: s Phone: 503.718.2439 Fax: 503.598.19 \r Date/13 : it/lac i C 1 t�Q Inspection Line: 503.639.4175 RECE� v Ready Date/By: H See Page 2 for i Internet: www.tigard-or.gov Notified/Method: Pry Supplemental Information ❑New construction ❑Addition/alteration/re lac Please check all that apply(submit 2 sets of plans w/items checked): MN �' f IGARD ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: $ION 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 ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or ❑Emergency system. larger separately derived // ❑Addition of new motor load of system. Job#: Job site address: N) L 100HP or more. ❑"A","E "1-z","13", -7744,p /�j ❑Six or more residential units. occupancy. City/State/ZIP: ek_ 9727 3 ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: I 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: ! �-; � 5 ci i/134/1 17 t°d�2i �ftif -✓Z°-6 Ne r resi ��`• 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 I /� �/ Limited energy,residential 75.00 2 /�,r7-Rt it e --"-V4 f� /') i i f �1 (with td energy,sq.ft.) J/TL Limited energy,muhi-family 75.00 2 residential(with above sq.ft.) Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation _ Name: t� �4ee/s 200 amps or less 100.70 2 Address: j Z� , 1/ - 201 amps to 400 amps 133.56 2 / 401 amps to 600 amps 200.34 2 City/State/ZIP: 776,,,q-e, ©� 91u� 601 amps to 1,000 amps 301.04 2 Phone:( )' C ✓ 47 f? I Fax:( ) Over 1,000 amps or volts 552.26 2 / Temporary services or feeders installation,alteration,and/or Email: e._,),,,„-,S 3i 0 <eQf9'' relocation Owner installation:This installation Moeing 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: 4( �Q�1, 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 -✓ty 'Y 2 Address: branch circuit DI City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) 1 Fax: :( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: Reconnect only 67.84 2 Pump or irrigation circle 67.84 _ 2 Business name: CiVA,P�y/ Sign or outline lighting 67.84 2 Address: Signal circuit(s)or limited energy ❑ See Page 2 2 panel,alteration,or extension. City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) I Fax:( ) Investigation(1 hr min) 66.25/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: I Electrical Lic.: I Suprv.Lic.: specifically listed %hr min Suprv.Electrician signature,required: Subtotal: 5, Id' Print name: Date: ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): ?IT Authorized signature TOTAL PERMIT FEE: K' �_62 /�,�� This permit application expires if a permit is not obtained within 180 Print name: e� i Date:S� /j days after it has been accepted as complete. • Number of inspections allowed per permit. 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 440-4615T(I1/05/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, Each Total I " 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: El 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) El 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 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr s. ificall listed %2 hr min 14COM11! CIAL.WORWONLYs , 1'1 / )!,i ±r e "_ Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): y • Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: El Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems El Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation El Intercom and Paging Systems El Landscape Irrigation Control* ❑ Medical El Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling El 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 Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical,and plumbing permits. Licensed architect and engineer applicants,exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that a II subcontractors who work on the structure must be licensed with the Construction Contractors Board. or V+ I will be performing work on property I own, a residence that I reside in, or a residence that I w ill reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. -fin 11 Print Name of Pe "Applicant gob Signature of Permit Applicant Da tC/O/C- Permit#: /=LC,(/«l-1 jC0''e-'+-'.rj ir--c cf;` • F Address: /020 7/ (RAJ /11.3 /9/. � `' Issued by: iJ -1- Date:S/iM5— /4 This Copy for Permit Offices