Permit CITY OF TIGARD ELECTRICAL PERMIT
`�1 s COMMUNITY DEVELOPMENT Permit#: ELC2015-00764
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/22/2015
Parcel: 2S110AB00900
Jurisdiction: Tigard
Site address: 14255 SW 112TH AVE
Project: Lee Subdivision: COLE'S ACRES Lot: 6
Project Description: (3)branch circuits for dryer,washer and bath fan.
Contractor: AFFINITY ELECTRIC LLC Owner: LEE, MICHAEL J
24506 NE 72ND AVE 14255 SW 112TH AVE
BATTLE GROUND,WA 98604 TIGARD, OR 97224
PHONE: 971-400-5354 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 09/22/2015 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/22/2015 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 OA' •5 -4!-00.0. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
1
Issued By: e '�// 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' A Date:
•
LICENSE NO. 5J
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 ApplicatiOIRECEIVED Receive
FOR OFFICE USE ONLY
City of Tigard , I'er nil'.4-1-4,20/5—De 74 /
,� - `J f g Date/By:� o?e2. � /
13125 SW Hall Blvd.,Tigard,OR 97223 SCD 2 2 2015 Plan Re ew
Phone: 503.718.2439 Fax: 503.598.19110 Date/By: Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: kids' El See Page 2 for
I I V A R D Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK PLAN REVIEW
❑New construction [4,.Addition/alteration/replacement Please check all that apply(submit 2 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.
7] 1-and 2-family dwelling ❑Commercial/industrial ❑Accessoi'c hui!Wing 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 El Emergency system. larger separately derived
Job#: Job site address: t(2.c C 7� ) ('z 4/ ❑
Addition of new motor load of system.
I OOHP or more. ❑"A","E","1-2","1-3"
City/State/ZIP: 1 ❑Six or more residential units. occupancy.
l r � ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: L EL' El Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qis. i Each I Total 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'l 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
75.00 '
(with above sq.R.)
_ Limited energy,multi-family
residential(with above sq.ft.) 75.00
�-*tiS ( 6o h ' ' " f , Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: L 66 200 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 l
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 0 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
service or feeder fee,first / 56.18 2
Address: branch circuit
City/State/ZIP: Each add'I branch circuit o2 7.42 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: (Il,e4": i ( E (avfr.C L.�C Sign or outline lighting 67.84 2
+� /J Signal circuit(s)or limited-energ■
Address: Z h Co 6 M I 7 Z"1 4-V•_. panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: gc„,f4 f e rQU t �A 9 e�+-( Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:c9 4_0 t.(Q p_ S-3 St.( I Fax:( ) Investigation(I hr min) 90.00/hr
industrial plant(1 hr min) 78.18/hr
Email: A-C-CZ„;+y`0 is e,fr`e t(e Q(��,�re,4( . `p,,i Inspections for which no fee is
90.00/hr
CCB Lie.:'_Q } Electrical Lie.: L' (Q5('( I Suprv.Lie.:c g5�S specifically listed(Yz hr min) i
.� G ELECTRICAL PERMIT FEES
Suprv.Electricifild 3' attire,required: 7/� /07/.4 Subtotal: 7/, 0.2.
Print name: t/SLAA) S1.t/1-p-i I Date: 9 f Z Z(i 5 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): d ,,51.2-
Authorized signature: TOTAL PERMIT FEE: 79,5" .
This permit application expires if a permit is not obtained within 180
Print name: I Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
L\Building'.Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-46151(11/05/COMUWEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Uescriphou I Qt). Each I Total 1 .
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
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:
n Burglar Mann 25.01 to 50 kva 301.04
50.01 to 100 kva 552.26 _2
❑ Garage Door Opener* >100 kva(Tee in accordance
with OAR 918-309-0040) 552.26
❑ 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
charged at an hourly(1 hr min) 66.25/hr
Inspections for which no fee is 90.00%hr
specificall■ listed I',hr mint
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I):
Fee for each commercial system: $75.00
(SEE OAR 918-309-0000) • Number of inspections allowed per permit.
Check Type of Work Involved:
n Audio and Stereo Systems
I Boiler Controls
Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
HVAC
Instrumentation
Intercom and Paging Systems
Landscape Irrigation Control*
Medical
Nurse Calls
Outdoor Landscape Lighting*
Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:Building'Pe tmits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015