Permit 11111 _ n CITY OF TIGARD ELECTRICAL PERMIT
� ' COMMUNITY DEVELOPMENT Permit#: ELC2015 00668
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/20/2015
Parcel: 2S 111 AA02800
Jurisdiction: Tigard
Site address: 8640 SW GREENSWARD LN
Project: Sharpe Subdivision: GREENSWARD PARK Lot: 10
Project Description: (2)branch circuits for new furnace and a/c
Contractor: GENESIS ELECTRIC NW Owner: SHARPE,JAIME
3753 KIENTHORPE WAY 8640 SW GREENSWARD LN
WEST LINN, OR 97068 TIGARD, OR 97224
PHONE: 503-303-8056 PHONE:
FAX: 503-303-8605
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 08/20/2015 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/20/2015 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ccordance approve• plans. This permit will expire if work is not started within 180 days of issuance, or if work i uspended for more the 180
days. TTENTION: Oregon equkres you to follow the rules adopted by the Oregon Utility Notification Center. TOeSe ar" set forth in OAR
95 01-0010 through OAR 952-,`1-0090. oil may obtain a copy of the rules or direct questions to OUNC by callin! • 32.198 by1".$r•+� 2344
Issued By: /� G�� Permittee Signature: ��� / I •, `
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:
1' OR INST TION ONLY
SIGNATURE OF SUPR.ELEC' C`'` t Date: f S
LICENSE NO. 50--S-15- S
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 App I i caEIVEJ) FOR OFFICE USE ON I 1
Received /56...1)12 6..,e,.9.0,5.--._60/- (�
City of Tigard Date/By: 0, Permit 6: CO O
Ill - 13125 SW Hall Blvd.,Tigard,OR/p ay 3� 0 2015 Plan Review
Phone: 503.718.2439 Fax: 503. 0 Date/By: Related Permit#:
Inspection Line: 503.639.4175 ry,/ r / l� Ready Date/By: Ions. El See Page 2 for
I ir,ARI g g ld f OF IIUA[�� Supplemental
Internet: www.ti and-or. ov Notified/Method: age 2 Information
TYPII&AM*DIVISION PLAN REVIEW
❑New construction iln,Addition/alteration/replacement Please check 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.
TZ11-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14.000 ❑Commercial-use agricultural
amps for all other installations.
❑Multi-family ❑Master builder ❑Other: bui
❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: I Job site address: g6 y� (�Jwe iti5�i 7�4 ❑Addition of new motor load of system.
/' `ti 100HP or more. ❑"A" "E" "I-2" "1-3°
Ci /State/ZIP: . . 2 '2.22 ❑Six or more residential units. occupancy.
ty �CT/�"`�� ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: p/� / ❑Hazardous locations. ❑Supply voltage for more than
/!G ��"
0 Service or feeder 600 amps or sore. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I i to al I '
New residential single-or multi-family(ladling 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
DESCRIPTION OF WORK Limited energy,residential
� 7n� ���Q (with above sq.ft.) 75.00
/ J L" .) AiC� 5/s i�,e, 6.c Limited energy,multi-family
residential(with above sq.fl.) 75.00 _
çTz' E ��� Renewable Energy ❑ See Page 2
PROPERTY 01'NER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 _
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 _
Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 -
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This instillation is being made on property that I own which is not 200 amps or less 59.36
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 _
Owner signature: Date: 401 amps to 599 amps 168.54 -
❑ 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 p
Address: service or feeder fee,first / 56.18 56•�d
branch circuit
City/State/ZIP: Each add'I branch circuit / 7.42 7.'Z, 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: �`-;,„,,845 . r,C �G /Z/G� Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: ,j7 ,53 7 /1/0.49T- c ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP: L � d Each additional inspection over allowable in any of the above
9 7D6Additional inspection(1 hr min) 66.25/hr
Phone: :031 3 g ace- Fax:( ) Investigation(1 hr min) 90.00/hr
- Industrial plant(1 hr min) 78.18/hr
Email: Se_ 5 /C Alc-3@ sz,7. G t e/a ir-- Inspections for which no fee is
CCB L1c.: 41a /3 electrical Lic.0 p ." specifically listed('/:hr min) 90.00/hr
.... ELECTRICAL PERMIT FEES
Suprv. !ethic an sign)ture,required:'�'��� Subtotal: 6 ?j.6 v
Pri nt name: f ,TTlC? ,A...4... .4"..-
� �� Date: .A(� ❑Plan Review Required(25%of permit fee):
//JJJJ �f� State surcharge(12%of permit fee): 7. (,3+
Authorized signature: TOTAL PERMIT FEE: 7J taZ
t 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.
I:\Building\Pennits\ELC_PermnApp_ELR_ERE.doc Rev 06/17.2015 440-4615T(11!05COM/wEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY:_ FEE SCHEDULE
nescript ion [ Qq. I Each I Total I "
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
2
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:
[ I 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
Vacuum Systems* >100 kva—no additional charge 0.0 3
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 mint
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
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
n Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
Instrumentation
Intercom and Paging Systems
Landscape Irrigation Control*
[ Medical
[ Nurse Calls
Outdoor Landscape Lighting*
U 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-'172015
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
8640 SW GREENSWARD LN, TIGARD, OR,
97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00668
David Young
Violation Summary:
Inspector Contractor