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Permit 1� � „ CITY OF TIGARD ELECTRICAL PERMIT i - COMMUNITY DEVELOPMENT Permit#: ELC2015 00577 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/27/2015 Parcel: 2S102CA00219 Jurisdiction: Tigard Site address: 13145 SW ASH DR Project: Dahms Subdivision: VIEWCREST TERRACE Lot: 17 Project Description: (2)branch circuits for bathroom remodel Contractor: R& D ELECTRIC INC Owner: DAHMS,ARMIN &MARGARET PO BOX 868 10235 SW LANCASTER RD MULINO, OR 97042 PORTLAND, OR 97219 PHONE: 503-679-7987 PHONE: FAX: FEES Quantity Description Date Amount 2 crt Branch Circuits wo/Purchase 07/27/2015 $63.60 Specifics: Service or Feeder 1 ea 12%State Surcharge- 07/27/2015 $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 i -d subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be d••- in accordance • 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 day.. ATTENTION: Oregon ,w re.. -s you to follow the rules adopted by the Oregon Utility Notification C-nter. Those rules are set forth in OAR 95'-001-0010 thro gh OAR 952-00 -%r90. Y -y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1:87 or .800.;32.2344. I sued By: Permittee Signature: 1 alt.� . • l 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' X `j( v _ 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 (I R (II I It I 1 'N l ()NI 1 City of Tigard RECEIVEJ) 7 p-7 t 5N2 Permit#: EL6,96/5 v057'/ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review, g Phone: 503.718.2439 Fax: 503.598.1960 DaWB : Related Permit#: Inspection Line: 503.639.4175 )�.' Ready Date/By: runs: 0 See Page 2 for \I:I Internet: www.tigard-or.gov 2015 5 Notified/Method: Supplemental laformation TYPE OF Wtqltu of i'n;AKfr PLAN REVIEW ❑New construction Q A dition/alt ` Please check all that apply(submit sets of plans w/items checked): `t1������151�1� ❑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. Id l-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 JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived Job#: Job site address: it \ ❑Addition of new motor load of system. 131 l 5 `5 w �S y� Q c---, IOOHP or more. ❑"A","E","1-2","1-3", City/State/ZIP: `t ❑Six or more residential units. occupancy. 9 0.r C', d 1l 1 t ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.4: ` J Project name: p \_ ❑Hazardous locations. ❑Supply voltage for more than �\vM ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Twl I • New residential single-or multi-family dwelling unit. Subdivision: Lot 4: 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 DESCRIPTION OF WORK Limited energy,residential N k (with above sq.ft.) 75.00 2 2 � �� 1R S Limited energy,multi-family 75.00 2 TC- l k t ..).0 a,GI `5 'k C Lic residential(with above sq.ft.) Renewable Energy ❑ See Page 2 ❑ PROPERTY 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 2 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 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 ❑ 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 2 each branch circuit Contact name: B.Fee for branch circuits without lc( service or feeder fee,first t 56.18 _ 2 Address: branch circuit City/State/ZIP: Each add'I branch circuit i 7.42 `) 4 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 Business name: \$ t\ ,ec4z\:t✓ l tV L Sign or outline lighting _ 67.84 2 Signal circuit(s)or limited-energy Address: R.C ❑ see Page 2 2 j O ' 6 c4 panel,alteration,or extension. City/State/ZIP: \ ©�- ���j(�. Each additional inspection over allowable in any of the above v� 1�V V Additional inspection(1 hr min) 66.25/hr Phone:(.3)6-2°1,--7 9 g 7 Fax:( ) Investigation(I hr min) 90.00/hr Industrial plant(1 hr min) 78.18/hr Ernailiki5 ji R NS 11 ,„ .)e-A-- Inspections for which no fee is 90.00/hr CCB Lic.:\/3 59. 6 Electrical Lic.:E. 3• Suprv.Lic.:5a 5 2_1_5 specifically listed('h hr min) _ ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: ` X7 R . • . _ Subtotal: 3_- - Print name:cGke�-1- ti�)�� Date: 1.--2_ 1.1,.,(5 ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): • 7 6 3 Authorized signature: TOTAL PERMIT FEE: 1 '3 This permit application expires if a permit is not obtained within 180 Print name:� \ I Date:'-?`-�l{_ i 5 I days after it has been accepted as complete. 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 13145 SW ASH DR, TIGARD, OR, 97223 Residential - Electrical 199 Electrical final PASS - No C of O ELC2015-00577 Jeff Grove Violation Summary: Inspector Contractor