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Permit CITY OF TIGARD ELECTRICAL PERMIT • COMMUNITY DEVELOPMENT Permit#: ELC2015-00719 T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/08!2015 Parcel: 2S102CA00910 Jurisdiction: Tigard Site address: 9625 SW FREWING ST Project: DICKINSON Subdivision: VILLAGE GLENN Lot: 10 Project Description: Reconnect only. Contractor: Owner: DICKINSON, LAWRENCE L AND LORI J 9625 SW FREWING TIGARD, OR 97223 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 1 ea Reconnect Only 09/08/2015 $67.84 Specifics: 1 ea 12%State Surcharge- 09/08/2015 $8.14 Electrical Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $75.98 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 ¢7 of thew s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: _ /1 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 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. Aug 03 17 04:55a RPM Solutions 5032249277 p.2 Electrical Permit Application FOIL( , I "F c).1 \ City of Tigard � � `� ;O t;: : / Permits: �%�.ro `Or) / , - ° 13125 SW HaII Blvd.,-Tigard,OR 97223 Plan Review iii Phone: 503.718.2439 Fax: 503.598.1 I]ateJBy Related Permit N. Inspection Line: 503.639.4175 2 29;6 ® See Page 2 for f l G A R 0 Y heir Internet: www.tigard-or,gov S� 1...,„Notified/Method: 7'(y SupptemenealIaformatina �^ 1y ,z��t�1t,�:�r� l TYPE OF WORK '�TY ��t_ _1,11,i-6;10N PLAN REVIEW ❑New construction grAddition/alteration' CClp1C�1t=� 1- Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 am ❑Demolition 0 Other: ' psormorc ❑Building overdaeeuories where the amarlabk fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑floating buildings 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building has to ground,a exceeds 14,000 9 Comuecectal-age agriceutaal ❑Multi-famil' amps for all other installations. buildings. } ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 1S0 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. Iargx separately derived Job#: Job site address: C‘(¢'�S C S f ❑ 001-11oo meow motor load of system. �l t 100FTPormarc. ❑"A","E",°t_2,.,"t_3•, Cily/Slate,'ZIP:l'i >-ci cyg Cl� ?j ❑Six or more residential units. occupancy.V 0 Health care facilities Recreational vehicle parks. Suitc/bldg'api.#: Project name: ❑Hazardous locations. ❑Supply voltage for more than I' ❑Service or feeder 600 amps or more. 600 volts nominal. Cross streetfdirl lions to job site: t� 1 (vim b L& FEE SCHEDULE "�J v uscriosoe ! Qtr. L Est* I Total 1 • New residential single-or multi-family dwelling nail. Subdivision: Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Fa.add'/500 sq.ft.or portion 33,92 I r {� /t [ p �. DESCRIPyTII.ONN OF WORK Limited energy,residential • 4l,Y id�+�++YiL• �J V S ,f�� (with above sq.ft) 75.00 2 ,,,,pp �` Limited energy,multi-family c Q Q(), n t-C.� _ residential 75.00 2 i -�+r [ �r Renewable Energy above sq.ft.) 13 PROPERTY OWNER ❑ TENANT rg r O Sere Page 2 � A (..X. 41 Services or feeders installation,alteration,and/or relocation 1 Name: W�1 200 amps or less 1 I 100.70 2 Address: Li -L j uw o t.1 201 amps to 400 amps 133.56 2 t� 401 amps to 600 amps l 200.34 2 City/State/ZIP: )b,, O �A" 601 strops to 1,000 amps 301.04 2 Phone:(9)3)r(tj 394', Fax:( ) Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or 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 Q CONTACT PERSON Branch circuits-new,alteration,or extension.p,er panel Business name: j,; r y ,, e y 'u 0,�� A.above for branch circuits ea with 1`�tLt C f�(j7� J nbrrve service or fender fee, Contact name: .o9L 1{ each branch circuit _ j 7.42 2 r• t B.Fee for branch circuits wrthoat service or feeder fee,first Address: 52 N -n Au t.. s e 56.18 2 J f�J1 J `�.► branch circuit CitylState/ZIP: Y�0� n6 ©e. ”! /Zt O Eachadd'I branch circuit 7.42 /..,-�' Miscellaneous(service or feeder not included) Phone:(�y,�-y Z�a Fax::( }�� `'� Each manufactured or modular 1784 1 2 Email: t ( AYzt Aiye)S_ C.,Ej,M dwelling,service and/or feeder Reconnect only 1 67.84 6).ill 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: (j( y" r - uy �L. Sign or outline lighting 67.84 2 Address: ^�1,�1 1 Signal circuit(s)or limited energy ❑ See Page 2 2 panel,alteration,or extension City/StateJZIP: Each additional inspectioa over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr Email tndustnal plant(1 hr min) XIS(hr Inspections fhr which no fee is CCB Lic.: Electrical Lie.: Suprv.Lie.: specifically listed('S hr min) 90.001 hr ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: (7. Print name: T Date: ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): 1r,/y Authorized signature:,- TOTAL PERMIT FEE: --75-. (� _A, ` , This permit appliance expires if a permit is not obtained within 180 Print name: f_.Q}..% =; - 4 ! I Date: 9'' 12_i l ' I days after it has been accepted as complete. • 5/umber of inspections allowed per permit. Clluildiaggh mitsELC_Pcnni,App ELR_E.AEdoc Rev 0611'2015 440-46115T(I:!O5,CO]A/WEa Aug 03 17 04:54a RPM Solutions 5032249277 p.1 �MA G^ r Ft. OVER SHEET SOLUTIONS Fax Fax To: City of Tigard I Fax Number: 503-598-1960 ATTN: Brenden Fax From: Real Property Management Solutions Number of pages(including cover): 3 Phone: 503-224-3002 Fax:503-224-9277 Subject: Reconnect Permit Brenden, Attached is the form we discussed. Please let me know if you need anything else from me. I need to make sure the electricity is turned back on sooner rather than later. Thank you for all of your help! Lacey Smith Business Operations Real Property Management Solutions 503-224-3002 ©Real Property Management Solutions Page 1 of 1 503-224-3002 •522 NW 23RD AVE—G PORTLAND, OR 97210•WWW.REALPMSOLUTIONS.COM Each Office is Independently Owned and Operated 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 9625 SW FREWING ST, TIGARD, OR, 97223 Residential - Electrical 199 Electrical ﬁnal PASS - No C of O ELC2015-00719 Jeff Grove Violation Summary: Inspector Contractor