Permit - q CITY OF TIGARD ELECTRICAL PERMIT
I COMMUNITY DEVELOPMENT Permit#: ELC2015 00801
Date Issued: 10/05/2015
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S109BA02400
Jurisdiction: Tigard
Site address: 13991 SW ALPINE VIEW CT
Project: SWANSON Subdivision: HILLSHIRE SUMMIT Lot: 9
Project Description: Moving garage electrical outlet from interior to exterior.
Contractor: OWNER Owner: SWANSON,JESSE&MELISSA D
JESSE SWANSON 13991 SW ALPINE VIEW CT
13991 SW ALPINE VIEW CT TIGARD,OR 97224
TIGARD, OR 97224
PHONE: 916-960-3600 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 10/05/2015 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/05/2015 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 r - 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' i•py of the rules o •irect questions to OUNC by calling 503.232.1987 or 1.800,332.2344.
Issued By: 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 pormit 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.
Elecfrical Permit Application FOR OFFICE I SE 011.1
City of Tigard Received t
Date/B : �li
. 'I 13125 SW Flail Blvd.,Tigard,OR 97223 `'�� Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 V` Date/B : Related Permit#:
Inspection Line: 503.639.4175 G V Ready Date/B y: 10 See Page 2 for
TIGARD Internet: www.tigard-or.gov �� C �0�� Notified Method: • Supplemental Information
TYPE OF WORK (�C l ` O� PLAN REVIEW
❑New construction ®Addition/alteration/reply peft 1\ Please check all that apply(submit 2 sets of plans w/items checked):
❑ Demolition ❑Other: Cj\�`( `vN�O`V ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTIi�� exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
Multi-family Master builder Other:
amps for all other installations. Installation❑ y ❑ ❑ El pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 13991 SW Alpine View Ct 100HP or more. ❑"A `E","1-z °I-3
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.crpa
❑Recreational vehicle parks.
❑Health-care facilities.
Suite/bldg./apt.#: Project name: ,_v.,i_vIS 0....„...7 ❑Hazardous locations. ❑Supply voltage for more than
� ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:Benchview FEE SCHEDULE
Description I Qty. [ Each I Total I '
New residential single-or multi-family dwelling unit.
Subdivision: Hillshire Summit Lot#:9 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: R2041856 Ea.add'(500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
Move 220 V/50 Amp outlet from interior of Garage to exterior (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
0 PROPERTY OWNER I ❑ TENANT Renewable Energy ❑ See Page 2
. Services or feeders installation,alteration,and/or relocation
Name:Jesse Swanson 200 amps or less 100.70 2
Address: 13991 SW Alpine View Ct 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,OR 97224 601 amps to 1,000 amps 301.04 2
Phone:(916)960-3600 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 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: /0 •' ,_,5 401 amps to 599 amps 168.54 2
❑ PLICANT ❑ 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 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 1 56.18 57 2
branch circuit J�
City/State/ZIP: Each add'(branch circuit 7.42 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: Cv?t�nJGt�' Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy
panel,alteration,or extension. - oee Page 2 2
City/State/ZIP: Each additional inspection 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: Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv. Lic.: specifically listed('/2 hr min)
Suprv.Electrician signature.required: ELECTRICAL PERMIT FEES
Su
p g 9 Subtotal: _ ,(r
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 71
Authorized signature: TOTAL PERMIT FEE: _6)., y�
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.
(:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-46151(11/05/COM/WEB