Permit (116) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016-00024
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/14/2016
Parcel: 2S103AC06900
Jurisdiction: Tigard
Site address: 12933 SW 113TH PL
Project: KILLIAN Subdivision: FONNER WOODS Lot: 5
Project Description: (2)branch circuits for office alteration.
Contractor: BRANDON KING ELECTRIC LLC Owner: KILLIAN, RICHARD V
18400 NE HILLSIDE DRIVE NOXEL, SHERRI A
NEWBERG, OR 97132 12933 SW 113TH PL
TIGARD, OR 97223
PHONE. 503-538-2727 PHONE:
FAX
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 01/14/2016 $63.60
Specifics: Service or Feeder
1 ea 12%Slate Surcharge- 01/14/2016 $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 rutted 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 copy
he r0 ules or du t questions to OUNC by calling 5012 or 1.80 . 2.2344.
Issued By: Signature:
OWNER INSTALLATION ONLY L/
The installation is being made on property I awn 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 re a conspicuous place on lhejob site until completion of the project.
Approved plans are required on lhejob site at the time of each inspection.
Electrical Permit Application `1�Q
Ci o Tigard V Rete"°a
},�� "' H Itb
Q,�, Permit
+ 13125 SW Hall Blvd.,Tigard,OR 9 vty�r�6` `L�\ A Plan Review
Phone: 503.718.2439 Fax: 503.598 \\1 Qvate/B Related Permit d S7 —
Inspection Line: 503.639.4175 ,P\v , P dv Date/11, ro" ® See Page i for
woui
Internet. www.tigud-or.gov \ �.I�j� Notifed/Method: Supplemental Informaaon-J
TYPE OF WOR 7\ V PLAN REVIEW
❑New construction EAddition/alteratioit� ment Please check all that apply(submit 2 sets of plans w/items checked).
vv�- ❑Service or feeder 400 amps or more ❑Building over three stones.
❑ Demolition ❑Other: where the available fault current ❑Mannas and boatyard,.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
I-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building 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 ❑Emergency system. larger separately denied
❑Addition of new motor load of stem.
Job#: Job site address: \Z°S33 S k.J ?j�a"x IooHP or more. ❑"A" 'E',1-2",'1-3
f
[I Six ur more residential on its. occupancy
�'I .
'ty/$fate/ZIP: \ v cvc\ 0 \ (�Z� ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project time: ❑Harzrdous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 .Its nominal.
Cross street/directicns to job site: S W O n V1f f FEE SCHEDULE
marri lion I Qty. I Earl
_ New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sqit or less 168.54 �1
lax map/parcel#: Fa.add'I 500 sq.R.or portion 3392 I
DESCRIPTION OF WORK Limited energy,residential 7500
Q C s �'C u, %j:' with above sq.
Limited energy,multi-family
ifamily 75 00
D�,c_e o_sixaA;,VX residential(with above s .it)
PROPERTY OWNER ❑ TENANT Renewable Energy ❑ See Pa e 2
t Services or feeders installation,alteration,and/or relocation
Name: i G�Gl17v - I fJt� � 200 amps or less 100.70
Address: `233 S(„� 11�� WIC 201 amps to 400 amps 133.56
I� 401 amps to 600 amps 200.34 _
City/State/ZIP: ` 1
0.l0� � �p 223 601 amps to 1,000 amps 301.03
Phone:( ) �a S4,'3 3Qh'� Fax,( ) Over 1,000 amps or volts 55226 _
Temporary services or feeders installation,alteration,and/or
Email relocation
Owner installation: This installation is being made on properly that I own which is not 200 amps or less 5936 1
intended for sale,lease,rent,or exchange,according to ORS 447.449,670,and 701. 201 amps to 400 amps 12508 _
Owner signature:_ Date: 401 amps to 599 amps 168 54 42
❑ Branch circuits-new,alteration,or extension,per panel
APPLICANT CONTACT PERSON _
\ A.Pee for branch circuits with
Business name: A,,,d-osA IC L .� LLC above service or feeder fee, 742
each branch circuit _
Contact name: trc , r B.Fee for branch circuits without
y i service or feeder fee,first
Address: - L branch circuit 56.18 t— _
City/Stale/ZIP: Each add']branch circuit 7.42
Miscellaneous service or feeder not included
Plione:(5c7)) 5-300pO 2n, ZOe Fax: :( ) Each manufactured or modular 6784
_ dwelling,service and/or feeder _
Email: �c r �fi�.t\tL4 (Q� Caf.� ,O V\,:� Reconnect only 67.84 _
CONTRACTOR Pump or irrigation circle 67.84
Business time: I('( D l r I ( x L� Sign or outline lighting 67.84 _
Signal circuits)or limited-energ)
Address: ,- c N L I{ a�.J` panel,alteration,or extension. ❑ See Page 2 _
City/State/ZIP: ( r� Ea Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
[,hone:4�,`� -7 rL-,7kt Fax:( ) Investigation(I hr min) 9000/hr
Ismail: Industrial plant(I hr min) 78.18/hr
ti 'IPX Inspections for which no fee is
s 90.00/hr
CCB Lic.: I1�Cts Electrical Lic.: 'j Suprv. Lic.a�j S roificall y listed('G hr min) -- -
+ / ELECTRICAL PERMIT FEES _�—
Suprv. Electrician
1 sig t + aired: I0 t f w Subtotal by
Print name: 'yti,i. �oDate: Ok �L "t0 ❑Plan Review Required(25%of permit fee). +c—_
—J�- State surcharge(12%of permit fee): J _
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained ninon IRP
Pi int name: Date: days after it has been accepted as complete.
I
�JJ Number of inspections allowed per perm.
\auildingAPermits\FIR.PermitApp_ELR EREdoe Rev06/17/2015 4404615T(II/nvCOMAVE11
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
12933 SW 113TH PL, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00024
David Young
Violation Summary:
Inspector Contractor