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Permit
CITY OF TIGARD ELECTRICAL PERMIT 1111 11 — COMMUNITY DEVELOPMENT Permit#: ELC2015 00729 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/10/2015 T f GARL� Parcel: 2S 110DD08400 Jurisdiction: Tigard Site address: 15780 SW HIGHLAND CT Project: Birkemeier Subdivision: SUMMERFIELD NO.6 Lot: 300 Project Description: Panel replacement,and adding(5)branch circuits in bathrooms,kitchen,garage,and exterior of home. Contractor: CHEROKEE ELECTRIC CO Owner: BIRKEMEIER, BRENT&JAN 13019 SW BRADLEY LN 15780 SW HIGHLAND CT TIGARD, OR 97224 TIGARD, OR 97224 PHONE: 503-209-9039 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders-200 09/10/2015 $100.70 Specifics: amps or less 5 crt Branch Circuits w/Purchase 09/10/2015 $37.10 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 09/10/2015 $16.54 Electrical Type of Const: Occupancy Grp: Total $154.34 Required Items and Reports(Conditions) This permit -• 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 , 'th 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 da . ATTENTION: Oregon law • ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 9 '-001-0010 through OAR 95 -0%1-0098. may obtain a copy of the rules or direct questions to OUNC by calling 503.232 7 or 1.800 32.2344. 1 Is •d By: (/ V � Perm Signature: r� 7. 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: CONT CTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' 4 Date: LICENSE NO. CQ ( 6 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 Application °.® 1-(112 (,F1-I( 1- 1 SI OM.1 City of Tigard \\1 P Receiv d i ' .'' Permit No.: C — dab i r 13125 SW Hall Blvd.,Tigard.*-'C1 Plan Review 'PI Phone: 503.718.2439 Fax: '..1960 `L51� Date/By: Other Permit: / I `V l l Inspection Line: 503.639.4175 c Q , Qo Date Ready/By: Lurie: la See Page 2 for Internet: www.tigard-or.gov J� �(�3�T SON Notified/Method: /�'e Supplemental Information TYPE OF Oc 0��1 PLAN REVIEW NV,G El New New construction Addition/a It��jj�L' Please check all that apply amps(submit 2 sets of plans items checked below): ❑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. less to ground,or exceeds 14,000 ❑Commercial-use agricultural 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building 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 system. ❑Addition of new motor load of ❑"A","E","1-2","1-3", Job no.: Job site address: �^r�p� `/ /- / I00HP or more. occupancy. Q p /.gyp/O S� (�fC,►/t( ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP: �'e,a r,[ t ©/` !'7ZZq / ❑Health care facilities. ❑Supply voltage for more than ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: I Project name: a r k_ pnt,e j e - ❑Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total I New residential single-or multi-family dwelling unit. S(A-14"-lMr r'-r e�� Includes attached garage. Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4 Ea.add'I 500 sq.ft.or portion 33.92 1 Tax map/parcel no.: Limited energy,residential 75.00 2 DESCRIPTION OF WORK (with above sq.ft.) / A / n� Limited energy,multi-family 75.00 2 i Pert( /aC- fl�C fail L1O( ABC GET residential(with above sq.ft.) F.,l y �� ps t / /� / 1p � Renewable Energy I 0 See Page 2 l vl bags s k,"-tatet/l 00. -,,ket,r" -G.1 a- ac trt P ¢ 'tj c t r, ,Services or feeders installation,alteration,and/or relocation d PROPERTY OWNER I "❑ TENANT 200 amps or less / 100.70 00.74) 2 201 amps to 400 amps 133.56 2 Name: V_ - Tom} ;J:Jl'd'heme;,t� 401 amps to 600 amps 200.34 2 Address: 601 amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 552.26 2 City/State/ZIP: Temporary services or feeders installation,alteration,and/or Phone:( ) I Fax:( ) relocation 200 amps or less 59.36 1 Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: Branch circuits—new,alteration,or extension, .er panel ® APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with `/ above service or feeder fee, 7.42 2 Business name: c_- k'�.e. G1, ,G .-.;H L each branch circuit . 3 e],1 O ---- B.Fee for branch circuits without Contact name: - .S . V'l'l e.j- service or feeder fee,first 56.18 2 branch circuit Address: (30 i q St t) grace ley Lei Each add'l branch circuit 7.42 2 q Miscellaneous(service or feeder not included) City/State/ZIP: ,Jce ©� ! 72.2 y Each manufactured or modular t / dwelling,service and/or feeder 67.84 2 Phone:(,,a3 ) zoq_ go37 I Fax: :( ) Reconnect only 67.84 2 E-mail: s-c_r i VV(er roo r;Lo(• Cowl Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: l.� , ,-v kee L z /G/e Signal circuits)or limited energy See ��L panel,alteration,or extension. Page 2 2 Address: 1301? std rOf fey Each additional inspection over allowable in any of the above City/State/ZIP: / q Additional inspection(1 hr min) 66.25/hr ty / C�Qr ©� [ 7Z2 " Investigation(1 hr min) 66.25/hr Phone:(.03 ) z99_ `1037 I Fax:( ) Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: 3-s,Fr1 I Electrical Lic.: _/.z7G I Suprv.Lic.:c26 1 6 S specifically listed('/2 hr min) _ ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: 1 ? Subtotal: /37, ri) Print name: ,,1 E Sc_r v4,e Date: ?Ji // Plan review(25%of permit fee): ` ` State surcharge(12%of permit fee): Authorized signature: 7 TOTAL PERMIT FEE: %� i This permit application expires if a permit is not obtained within 1 0 Print name: A.'.'a"l c ri�n Date: 91,01,,_ days after it has been accepted as complete. ■ Number of inspections allowed per permit. 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440.4615T(I1/05/COM/WEB L Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Fee for all residential systems combined $75.00 Description I Qtr. I Fee I 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 El Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 ElAlarm Wind generation systems in excess of 25 kva: 25.01 to 50 kva 301.04 2 El Garage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva(fee in accordance with 552.26 2 OAR 918-309-0040) ❑ Heating, Ventilation and Air Conditioning System* Solar generation systems in excess of 25 kva: Each additional kva over 25 7.42 3 El 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 charged at an hourly(1 hr mm) 66.25/hr 1 Inspections for which no fee is 90.00/hr specifically listed(V2 hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system $75.00 Subtotal: (SEE OAR 918-309-0000) Plan review,if required(25%of permit fee): State surcharge(12%of permit fee): Check Type of Work Involved: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 ❑ Audio and Stereo Systems days after it has been accepted as complete. * Number of inspections allowed per permit. n Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation El Fire Alarm Installation ❑ HVAC El Instrumentation ❑ Intercom and Paging Systems El Landscape Irrigation Control* El Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* El Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:\Buil ding\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 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 15780 SW HIGHLAND CT, TIGARD, OR, 97224 Residential - Electrical 199 Electrical final PASS - No C of O ELC2015-00729 Jeff Grove Violation Summary: Inspector Contractor