Permit IN CITY OF TIGARDjPr� ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2015-00496
T[GA D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 / Date Issued: 06/29/2015
Parcel: 2S111AD16100
Jurisdiction: Tigard
Site address: 15034 SW 91ST AVE
Project: Caminschi Subdivision: MALLARD LAKES Lot: 27
Project Description: Remodel of bathroom&closet,(2)branch circuits. 11/16/16,REPRINTED to add(1)add l branch circuit.
Contractor: OWNER Owner: CAMINSCHI,ANDREI&KIMBERLY S
ANDREI& KIM CAMINSCHI 15034 SW 91ST AVE
15034 SW 91ST AVE TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 425-753-6669 PHONE: 425-753-6669
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 06/29/2015 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 06/29/2015 $7.63
Type of Use: SF Electrical
Class of Work: ALT 1 crt Branch Circuits w/Purchase 11/16/2016 $7.42
Service or Feeder
Type of Const: 0 ea 12%State Surcharge- 11/16/2016 $0.89
Occupancy Grp: Electrical
45 Misc Administration Fee 11/16/2016 $45.00
Total $124.54
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 rough 952-001-''90. You may obtain a copy of the rules or direct questions to OUNC by calling 57,32.1987 or 1.800.3324344.
Issued By: � Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
1
Electrical Permit Applicata 1 ' iT
� b R()I l l('►: ISE 0\1,l
City of Tigard Received � 1'; _ [�9s-
Date/B /,/L� i� Permit#: LCd.6CS 0c-t
13125 SW Hall Blvd.,Tigard,OR 97223 PlanDate/B Review
_ Phone: 503.718.2439 Fax: 503.598.19W)V 6 Z : Related Permit#:
T I G A Ii D Inspection Line: 503.639.4175 Ready Date/By: auris: See Page 2 for
Internet: www.tigard-or.gov , s t bx t0 I' Notified/Method:
1�,k i�1 k ) g$ : ;I. Supplemental Information
TYPE OF W '�'�1'i '?A� PLAN REVIEW
❑New construction 0 Addition/a11epi a.Cement Please check all that apply(submit 2 sets of plans w/items checked):
N
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other:
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTIONexceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: (�v 3 C/ - G�j/ c /1_J E ❑100H Addition mf oew motor load of system.
T !l /"r 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: 0 Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 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
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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
/� \ �1 '/C (with above sq.ft.) 75.00 2
1-SSV TD ffk/SPi,)a. Pt1211"il ( az —Ov`t/S + Limitithabo
_ nn In . energy,multi-family 75.00 2
a-(J t/ 6(l�A�-_� (_Lt clu� residential(with above sq.ft.)
❑ PROPERTY OWNER 0 TENANT Services
Energy 0 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:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Email:
Temporary services or feeders installation,alteration,and/or
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
0
APPLICANT 0 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
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
Email: dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: (f)//010 2 Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(/2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signatur TOTAL PERMIT FEE: #55.3
This permit application expires if a permit is not obtained within 180
Print name:r\ j w( C fit, ,ir15 Date: _i Le .[(p
„ days after it has been accepted as complete.
( � * Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 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 I Qty. I Each Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
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 over 25 7.42 3
n 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('/hr min)
fiLECTitICr�,i. PERMIT. FEES
COMMERCIAL WORKONLY: Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * 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.doe Rev 06/17/2015
n CITY OF TIGARD ELECTRICAL PERMIT
111 II - COMMUNITY DEVELOPMENT Permit#: ELC2015-00496
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/29/2015
Parcel: 2S111AD16100
Jurisdiction: Tigard
Site address: 15034 SW 91ST AVE
Project: Caminschi Subdivision: MALLARD LAKES Lot: 27
Project Description: Remodel of bathroom&closet,(2)branch circuits.
Contractor: OWNER Owner: CAMINSCHI,ANDREI & KIMBERLY S
ANDREI& KIM CAMINSCHI 15034 SW 91ST AVE
15034 SW 91ST AVE TIGARD,OR 97224
TIGARD, OR 97224
PHONE: 425-753-6669 PHONE: 425-753-6669
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 06/29/2015 $63.60
Specifics:, Service or Feeder
1 ea 12%State Surcharge- 06/29/2015 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports(Conditions)
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. AT ION: Or-.•n la equires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001 010 through OAR 9 r01-•,;1 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
/
Issu d By: / ` Permittee Signature: 'Y A"j cGn
J .���( 4�-
- OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent. 09//OWNER'S SIGNATURE t 14 _ ..//. ,A ./I A 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 Applicatl C
lEIVEP FOR OFFICE USE ONLY
City of Tigard Received
Date/B : O/�9 /` i
13125 SW Hall Blvd.,Tigard,OR 97271^∎ Plan Review
Phone: 503.718.2439 Fax: 503.598: BfJI 2 9 ?015 Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Juris: ® See Page 2 for
I It■ARI) Internet: www.tigard-or.gov CITY OF HO RD D Notified/Method: Supplemental Information
TYPE"eV Wo K 'itI N • PLAN REVIEW
❑New construction ❑Addition/alteration/replacement Please cheek 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.
El I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14.000 ❑Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family El Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: 1 , �j� C'`�P� ❑Addition of ore.motor load of system.
100HP or more. ❑"A" "E" "1-2" "1-3",
City/State/ZIP: �r-��(� �] ❑Six or more residential units. occupancy.
�1 9 1LV ()l 2— -La. i.,
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: ^%a.y e iA, ( ❑Hazardous locations. ❑Supply1t voltage for more than
❑Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Description I QIN. 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 -t
Tax map/parcel#:
Ea.WI 500 sq.ft.or portion _ 33.92 I
DESCRIPTION OF WORK Limited energy,residential
. A, DOet.) f t ()=4)r c I�e_ (with above sq.ft.) 75.00
'V l�ll /1 l Limited energy,multi-family 75.00
t l `e t l� t[ j L S� v---e(,Z )( residential(with above sq.ft.)
�' ` RQ�E� I 0 - Renewable Energy ❑ See Page 2
P RTY OWNER Services or feeders installation,alteration,and/or relocation
Name: 1 yn C�rn,L`-� 200 amps or less , 100.70
l 1�~f , ' 1 C 1 ' `, 9 f j� 201 amps to 400 amps 133.56
Address: t�lJ�-� `l f r[�/
ty / Q �� 401 amps to 600 amps 200.34 . 2
City/State/ZIP: V 601 amps to 1,000 amps 301.04
Phone:(4� _ (citeicri Fax:( ) Over 1,000 amps or volts 552.26
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 I
',K for sale,le�sg,rent,or exchange,according to ORS 447,449,670 and 7 I. 201 amps to 400 amps 125.08 2
\ Owner signature: ((� (� 1 Date: I. 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: above service or feeder fee,
7.42
each branch circuit _
Contact name: B.Fee for branch circuits without
service or feeder fee,first / 56.18 it 2
Address: branch circuit S
City/State/ZIP: Each add'∎branch circuit / 7.42 2 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
V�
Business name: ) t f2 Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy
panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(I hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90,00/hr
CCB Lie.: Electrical Lie.: S upr\. Lie.: specifically listed(A hr min) _ 1 -
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal: 613,fPb
Print name: Date: 0 Plan Review Required(25%of permit fee): ---'
State surcharge(12%of permit fee): 7.&
Authorized signature: TOTAL PERMIT FEE: 7/•01-•3 -
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
❑'Building Permits ELC_PermitApp_ELR_ERE.doc Rev 06/I 7'20l 5 440.4615T(11/05/COM/WEB
J
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description Qtr.
Fee for all residential systems combined: $75.00 Each Total I
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
7 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) _
I I Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
I 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(I hr min)
Inspections for which no fee is 90.00/hr
speci listed('_hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system:. $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
I I Boiler Controls
Clock Systems
I I Data Telecommunication Installation
I I Fire Alarm Installation
❑ HVAC
n Instrumentation
Intercom and Paging Systems
Landscape Irrigation Control*
❑ Medical
n Nurse Calls
Outdoor Landscape Lighting*
I I Protective Signaling
7 Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
IaBuilding,Permes`ELC_PermitApp_ELR_ERE.doc Rev 06/17,2015