Permit 1111111
CITY OF TIGARD ELECTRICAL PERMIT
� * • COMMUNITY DEVELOPMENT Permit#: ELC2015-00872
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/26/2015
Parcel: 1 S134BD07500
Jurisdiction: Tigard
Site address: 11627 SW PENN CT
Project: North x Northwest Subdivision: PENN LAWN ESTATES Lot: 3
Project Description: (2)branch circuits for bathroom remodel.
Contractor: NORTH BY NORTHWEST Owner: SCOTT, BJ
326 S 15TH ST. 11627 SW PENN CT
ST. HELENS, OR 97051 TIGARD, OR 97223
PHONE: 503-348-0505 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 10/26/2015 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/26/2015 $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 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. Y. i.- obtain a copy of the rules or direct questions to OUNC by calling 503.232.197 or 1 x00.332 344.
//\\
Issued By: , _ - Permittee Signature: ,�
/l OWNER INS • •TION 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.
Electrical Permit Application FOR OFFICE USE ONLY
Received
City of Tigard ` ie /OA/!y Permit 14: 42::(„C.,„20( UpSV-7,• v f' Dateline
111111
13125 SW Hall Blvd.,Tigard,OR 97223 ��, Plan Review
• Phone: 503.718.2439 Fax: 503.598.1'� Date/By: Related Permit#:Atevl' 5-----003 37
Inspection Line: 503.639.4175 a 1015 Ready Date/By: Juris: VI See Page 2 for
11 G A 1:D Internet: www.tigard-or.gov 00 I° Notified/Method: Supplemental information
TYPE OF WORK ^�V�C 1111GWi ` IA PLAN REVIEW
❑New construction IAddition/alteration Tk)S� C O,vl`� Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other: 1801. ['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.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
1-and 2-fancily dwelling 111 Commercial/industrial ❑Accessory building g
Multi-fttnil Master builder Other: amps for all other installations. buildings.
Y ❑ ❑ ❑Fire pump. ❑installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system, larger separately derived
Job#: Job site address: /j c ❑Addition of new motor load of system.
//f 5i,,/ �2N.✓G% 100HP or more. ❑"A" "E" "1-2""1-3„
City/State/ZIP: --y—� C{ / c ❑Hx Health-care more residential units. Recreational� t�9� 1 ��4`4j ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: V 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. 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 1
DESCRIPTION OF WORK Limited energy,residential
/,..)-€44444.1 1,11713 (with above sq.ft.) 75.00 2
Bf74, II A p/✓kZ. 4 Limited energy,multi-family 75.00 2
---/ residential(with above sq.ft.)
5`rde..1-1-e Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: J sL.0-1! 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 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 ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first / 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit / 7.42 2
Fax: Miscellaneous(service or feeder not included)
Phone:
( ) ( ) 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: ,{loz-� tt call 6 Sign or outline lighting 67.84 _'
Address: -2 `/j�I 15- — Lin Signal alteration,circuit(s)or limited-energy ❑ See Page 2 2
�+b panel,alteration,or extension.
City/State/ZIP: �— �� c�/>oy_ Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:6'0'5 ) 3yg, e5S05 Fax: ( ) investigation(1 hr min) 90.00/hr
D / Industrial plant(1 hr min) 78.18/hr
'y'
Email: //7 10i/4 Inspections for which no fee is
^ specifically listed('/hr min) 90.00/hr
CCB Lic.: jig/
iVIII Electrical Lic.: S 5ta. Suprv.Lic.:ii-L./6'�S
ELECTRICAL PERMIT FEES
Suprv.Electrician Ce,required: Subtotal:
Print name: -7-07 045 Date: ,y.26 _ i6 ❑Plan Review Required(25%of permit fee):
/ State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: f 7/_,)..3
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.
1:\Building\Permits 1ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-46151(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
Description Qty. I Each I Total I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 1 00.70 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:
❑ 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
Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ V• acuum 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 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(V,,hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00
Number of inspections allowed per pennit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ A• udio and Stereo Systems
Boiler Controls
n Clock Systems
n Data Telecommunication Installation
Ti F• ire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
( Landscape Irrigation Control*
I I Medical
Ti N• urse Calls
❑ Outdoor Landscape Lighting*
Ti Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\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
11627 SW PENN CT, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00872
Jeff Grove
Violation Summary:
Inspector Contractor