Permit t n
CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit#: ELC2015-00629
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/10/2015
Parcel: 2S 111 DD08300
Jurisdiction: Tigard
Site address: 8657 SW AVON ST
Project: Thompson Subdivision: CHESSMAN DOWNS Lot: 9
Project Description: Panel change
Contractor: TD ELECTRIC INC Owner: THOMPSON,JUDITH C
3807 NW 161ST WAY 8657 SW AVON ST
RIDGEFIELD,WA 98642 TIGARD, OR 97224
PHONE: 503-409-4867 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 08/10/2015 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 08/10/2015 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 - - •- - • approved plans. This permit will expire if work is not started within 180 days of issuance, or i work is suspended for more the 180
days. A NTION: Oregon - re• -- you to follow the rules adopted by the Oregon Utility Notification Center hose rules are se - in OAR
952-00 -0010 t • gh OAR 952-00 ,890 •u a obtain a copy of the r es or direct questions to OUNC by calling 503.232.198 1.80;332.2344
�,
Iss ed By: /W 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 INSTALL; : • •NLY
SIGNATURE OF SUPR.ELEC' Date: [i /G//5
LICENSE NO. 1 _ I1
7 7 S
Ca • .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 if)N 1)PEKE USE ONLY
City of Tigard 1 ! �� Received
IN Date/B : �� Permit#: �.� /, ,.
i 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review v
Phone: 503.718.2439 Fax: 503.598.1/MG 1 O 2015 Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Juris. ® See Page 2 for
I I t �is i Notifed/Method: Su pp lemental Information www.tigard-or.gov OF � �
TYPE iglysiceiklertW11.5TON PLAN REVIEW
❑New construction Addition/alteration/replacement Please check all that apply(submit 1 sets of plans w items checked):
El Demolition Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
I-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. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: I Job site address: aL h 7- 4�O'� 54— ❑Addition 0H of new motor load of system.
V✓ I OOHP or more. ❑"A","E","I-2","1-3",(r) occupancy.
Six or more residential units. P Y•
City/State/ZIP: 7 f G�} f'J 0 2 1-- 2� ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: //� �
c h ❑Hazardous locations. ❑Supply voltage for more than
/r'� � ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qts. I Each I Total I "
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add',500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
N rj /� /, (with above sq.ft.) 75.00
P �G1 �/ ' CK Limited energy,multi-family 75.00 2
Q residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less ` 100.70 I. 2
Address:
201 amps to 400 amps 133.56
401 amps to 600 amps 200.34
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 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 I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business n e: -f-6 - 1-sz -r-p t r above service or feeder fee,
7A2
each branch circuit 2
Contact name: , Pe . P Ai VD B.Fee for branch circuits without
Address: 3 go /V La W branch it feeder fee,first 56.18 2
���vvv branch circuit
City/State/ZIP: t; ✓t� r I e � �� Each add'I branch circuit 7.42
_ 1� Miscellaneous(service or feeder not included)
Phone:f-593) (409( u'e)--i_ I Fax: :( ) Each manufactured or modular
1 I dwelling,service and/or feeder 67.84
Email: A Ls2XAJ pj/f` 'L.4 Wyk—G L , C.0 LA.--.1 Reconnect only 67.84 _
CO CTOR Pump or irrigation circle 67.84
Business name: ^'� rr 1` Sign or outline lighting 67.84
( 1� �� �� / Signal circuit(s)or limited-energy ❑ See Page 2
Address: 3el? � / ,,,/ /b f 97f- w�y panel,alteration,or extension.
�J v" „ 6 y Each additional inspection over allowable in any of the above
City/State/ZIP: ^ ` l / J) �j W 6(,,�
r\ / , ' r` / Additional inspection(1 hr min) 66.25/hr
Phone:( ) I Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(I hr min) 78.18/hr
Email: �p/�3��LC -��/�l 7 tall/i�/ Inspections for which no fee is
CCB Lic.: (w b Electrical Lie.: 51-107... specifically listed '/A hr min) �/hr
"1 J I bl Suprv.Lic.: P� Y (
Suprv. Electrician signature,r fired: ELECTRICAL PERMIT FEES
/ Subtotal: M O 70
Print name: Date: gpr:Vi./3 ❑Plan Review Required(25%of permit fee): -�'
State surcharge(12%of permit fee): /,-c '
Authorized signature:
TOTAL PERMIT FEE: 7/,9.J�
This permit application expires if a permit is not obtained within 180
Print name: A.L,uv-ttJ J(j2 e: l b i h days after it has been accepted as complete.
Number of inspections allowed per permit.
1:\BuildingsPermits\ELC_PermitApp_ELR_ERE.doc Rev 06/17,2015 440-4615T(I1!0 C(OMI/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 Q . I Each I Total I "
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: s kva orless 100.70
5.01 to 15 kva 133.56
Audio and Stereo Systems* 15.01 to 25 kva 200.34 ,
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04
50.01 to 100 kva 552.26
n Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26
I I 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
Each additional inspection over allowable in any of the above:
n Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
inspections for which no fee is 90.00/hr
specilicall■ listed('_hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $755.00 Subtotal(Enter on Page I I:
(SEE OAR 918-309-0000) Number of inspections allowed per permit.
Check Type of Work Involved:
n Audio and Stereo Systems
Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
I I Outdoor Landscape Lighting*
Protective Signaling
Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
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
8657 SW AVON ST, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00629
Herb Stabenow
Violation Summary:
Inspector Contractor