Permit CITY OF TIGARD ELECTRICAL PERMIT
$11 COMMUNITY DEVELOPMENT Permit#: ELC2015-00585
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/29/2015
Parcel: 2S111BA05800
Jurisdiction: Tigard
Site address: 14145 SW 97TH PL
Project: PETERSON Subdivision: SOLARCREST Lot: 10
Project Description: (1)branch circuit for A/C reconnect.
Contractor: DISTINCT ELECTRIC, INC Owner: PETERSON, MICHEL E& LINDSAY A
4742 LIBERTY RD STE 219 14145 SW 97TH PL
SALEM, OR 97302 PORTLAND, OR 97224
PHONE: 503-910-9216 PHONE: 503 441-2119
FAX: 503-763-6880
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 07/29/2015 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 07/29/2015 $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 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 through OAR 952-001-0090. 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: � L •ermittee 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 FOR OFFICE USE ONLY
City o Tigard Received
hr f g CEO Date/B :
■ Li.. Permit ti: . 8-•lig 13125 SW Hall Blvd.,Tigard,OR 9722
a Phone: 503.718.2439 Fax: 503.598.1 Related Permits;: DC 015 - 1►
Inspection Line: 503.639.4175 ch VS Ready Date/By: ® See Page 2 for
I`' '1> Internet: www.tigard-or.gov .0-- �j Notified/Method: EMI Supplemental Information
-TYPE OF WORK 1101.0 PLAN REVIEW
111 Please check all that apply(submit sets of plans w/items checked):
❑New construction Addition/alteration/rt���i r vl�i0� pp y I �. p
t V D ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition Other: �1,��� where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRIXTION exceeds 10.000 amps at 150 volts or ❑Floating buildings.
''''A.7-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14.000 0 Commercial-use agricultural
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
Job#: Job site address: /COO -- S4 f gT? ❑Addition of new motor load of system.
f �PL I OOHP or more. ❑"A„ •,E,. „I_z„ „L3,•
` Six more residential units. occupancy.
Y•
City/Stale/ZIP: T � , �' ry*Z.?y ❑I leait h-care facilitie s.
0 Recreational vehicle parks.
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 Qtv. 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 I
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00
A c /4.2-E-Cr7itJ.w6C 7 Limited energy,multi-family 75.00
residential(with above sq.fl.)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER ❑ TENANT 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
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 I
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 1 68.54 2
❑ APPLICANT
❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
— A.Fee for branch circuits with
Business name: / 'r`-- above service or feeder fee.
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 56 branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 _ _
Miscellaneous(service or feeder not included) _
Phone:( ) Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84
Email: Reconnect only 67.84
CONTRACTOR Pump or irrigation circle 67.84
Business name: �(5'77,,,CT � iC ._.a/C Sign or outline lighting 67.84
Signal circuit(s)or limited-energy ❑ See Page 2
Address: u Z.4 Z ( (Zr-z,32'AV_ S , ` /7. panel,alteration,or extension. ,
City/State/ZIP: [S�. �� Die c Z.9 l . !
Each additional
nal inspection inspection over aHowable.2 any of the above
l Additional inspection(1 hr min) 66.25/hr
Phone:(re3) qla--Q z t‘ I Fax:(-S-Of) J ..‘er0 Investigation(I hr min) 90.00/hr
Email: larsrr vCr � (C POW/1/4. cps
Industrial s plant r(1 whhr ich no) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: !6(087 Electrical Lie.: 2 7 .577, Suprv.Lic.:3Crff specifically listed('/hr min)
Suprv.Electrician signature,required: r` ELECTRICAL PERMIT FEES
p e9 �` Subtotal: SC ( '
Print name: �,us„rA Ikt QU( Date: ❑Plan Review Required(25%of permit fee):
�' "` State surcharge(12%of permit fee): (0,71
Authorized signature:
TOTAL PERMIT FEE: t6,,? .2.2
This permit application expires if a permit is not obtained within 180
Print name: I Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\BuildingTermits ELC_PennitApp_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 I 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
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
❑ Garage Door Opener*
>100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ 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
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
sped Beall} listed('_hr mint
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I):
Fee for each commercial system: $75.00
(SEE OAR 918-309-0000) ` Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
Clock Systems
n Data Telecommunication Installation
H Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
Protective Signaling
I Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
l/Building\Petnits`ELC_PernitApp_ELR_ERE.doc Re,06 I'2015
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
14145 SW 97TH PL, TIGARD, OR, 97224
Residential - Electrical
145 A/C or heating unit circui
PASS
ELC2015-00585
Herb Stabenow
Violation Summary:
Inspector Contractor