Permit CITY OF TIGARD ELECTRICAL PERMIT
_
II n
II • COMMUNITY DEVELOPMENT Permit#: ELC2015-00860
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/21/2015
Parcel: 1 S134AD01100
Jurisdiction: Tigard
Site address: 11385 SW LAKEWOOD CT
Project: Varga Subdivision: ENGLEWOOD Lot: 51
Project Description: (2)branch circuits for hot tub/spa and generator change over switch.
Contractor: OWNER Owner: VARGA, RANDALL J &ALISA C
RANDALL VARGA 11385 SW LAKEWOOD CT
11385 SW LAKEWOOD CT TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-828-6137 PHONE: 503-828-6137
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 10/21/2015 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/21/2015 $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 ued .ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ' accordance with <pproved 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. TENTION: Oregon I- requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-0 1-0010 thr. gh OAR 952-01 '09 J. '.0 may obtain a copy of the rules or direct questions to OUNC by calling 503.23 7 r7800.3322344.
Is ued By: _ //- L�af� Permittee Signature: {/ik-
OWNER INSTALLATION ONLY
i
The installation is being made on prope I qwA which is not intended for sale,lease or rent.
OWNER'S SIGNATURE V k"---- Date: /e/a//
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.
Electrical Permit A licatio ECEIVED FOR OFFICE USE ONLY
Cl of Tigard Received n t� o/
- `J f g y Date/By: i'/`/ /S Permit#: �IJ 1 C/ 'OO 86O
'q 13125 SW Hall Blvd.,Tigard,OR 97223 r,T 2 1 2015 Plan Review
Phone: 503.718.2439 Fax: 503.598.19 Date/By: Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: orris: ® See Page 2 for
TIGARD CITY OF TIGARD
Internet: www.tigard-or.gov g���� ��NG DIVISION Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ['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.
L I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14.000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family ❑Master builder ❑Other: p p ❑Installation of 150 KVA or
❑Fire pump.
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: // 3 S S 5 vu ',k,,,v-z,vJ (.f 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: d r1 ❑Six or more residential units. occupancy.
tY / j y ow 1 7-2 2 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: ✓ Project name: ❑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 Qty. 1 Each 1 Total 1 *
�✓1 1. V� ` — e -n'jtNwd' New residential single-or multi-family dwelling unit.
Subdivision: J Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
'Fax map parcel Ea.add]500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
h( l`i` /I- T" h 5le- 4-- 6-c Ht---, 0" eft 4-- ''' ,
Limited energy,multi-family 75.00 2
Z -Y (.� residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: k',,, (7Y (/ 1/4 e- y 200 amps or less 100.70 2
Address: // 3 5 S vti IL o,k{moo 6. I-. 201 amps to 400 amps 133.56 2
( 401 amps to 600 amps 200.34 2
City/State/ZIP: Te ) --- c. 4 .7-2 Z '3 601 amps to 1,000 amps 301.04 2
Phone:(5'-3) ''Z$ CO I ? 7 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: v- - ✓/01.yr,h 9 i'YLo7 .r( Lo"'Ls 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,leas nt,or exchange,pc 56rding to ORS 447,449,670,and 7 1. 201 amps to 400 amps 125.08 2
Owner signature: ••✓dy t ✓ '✓ Date: Id 2-1 ( f 401 amps to 599 amps 168.54 2
[APPLICANT [ 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: Teyn,JiL C 1 V " .0\ B.Fee for branch circuits without 1
�� service or feeder fec,first
,A,,.„‘,€_,. ax n-`/ branch circuit 56.18 5414?�b 2
Address:
City/State/ZIP: Each add'I branch circuit / 7.42 7'CA Y 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
Email: dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: �//)--- Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. ❑ See 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(1 hr min) 78.18/hr
Inspections for which no fee is
u(1.00 hi
CCB Lie.: Electrical Lie.: Suprv.Lie.: shccificall■ listcd( =hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 4=x2.40
Print name: Date: ❑Plan Review Required(25%of permit fee): '
State surcharge(12%of permit fee): 7-4 3
TOTAL PERMIT FEE:
Authorized signature: / �/ •aZ 3
� V / This permit application expires if a permit is not obtained ssithin 180
Print name:(704,1,c6( t / v Date: id/2 l/( 3 days after it has been accepted as complete.
`` !!! * Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Res 06 172015 440-4615T(11/05/COM/WEB
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 Qty. I Each j. Total I k
y Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
I 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
with OAR 918-309-0040) 552.26 2
[ I Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
n 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 66.25/hr ]
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00
Subtotal(Enter t.Page I r
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
Data Telecommunication Installation
I I Fire Alarm Installation
n HVAC
Instrumentation
7 Intercom and Paging Systems
Landscape Irrigation Control*
I Medical
Nurse Calls
n Outdoor Landscape Lighting*
Protective Signaling
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 06/17/2015
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
11385 SW LAKEWOOD CT, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00860
Jeff Grove
Violation Summary:
Inspector Contractor