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Permit (188) CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2016-00051 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/25/2016 Parcel: 2S 103AC04400 Jurisdiction: Tigard Site address: 12567 SW 114TH TER Project: Ericksen Subdivision: WALNUT GROVE Lot: 13 Project Description: Alteration of(1)branch circuit for door installation,adding outside light and outlet. Contractor: OWNER Owner: ERICKSEN, RICHARD&SARAH RICHARD ERICKSEN 12567 SW 114TH TER 12567 SW 114TH TERRACE TIGARD, OR 97223 TIGARD, OR 97223 PHONE: PHONE: 503-504-3017 FAX: FEES Quantity Description Date Amount 1 crt Branch Circuits wo/Purchase 01/25/2016 $56.18 Specifics: Service or Feeder 1 ea 12%State Surcharge- 01/25/2016 $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 accordanc ith 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 1 days. TTENTION: Oreg la equires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR / 95 001-0010 through OAR 9 -001-0 9 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19 or 1.800.332. Issued By: _ Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on property I ow �ich��ent. OWNER'S SIGNATURE Date: O�T 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 Received Kel UL11111XLKWILI KII /* City of Tigard D te/By� / <�/* 6� Permit 9: 57 13125 SW Hall Blvd.,Tigard,OR Plan Review Phone: 503.718.2439 Fax: 503RFoCEIVE Date/By: Related Permit Inspection Line: 503.639.4175 Ready Date/By: Juris 0 See Page 2 for Internet: www.tigard-or.gov , I Notified/Method: Supplemental Information k�n j tEva ❑New construction Addition(alletfiYPlease check all that apply(submit 2 sets of plans w/items checked): A p q El Service or feeder 400 amps or more [I Building over three stories. 0 Demolition F-1 Other-R131 where the available fault current 0 Marinas and boatyards. _7 WN exceeds 10,000 amps at 150 volts or 0 Floating buildings. 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 El Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or 0A",RMVti 0 Emergency system. larger separately derived Job0 Addition of new motor load of system. I Job site address: 12567 SW 1141h Ter I OOHP or more. El"A","E","1-2","1-3", City/State/ZIP:Tigard,OR 97223 0 Six or more residential units. occupancy. 0 Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: _7-Project name:New door/electrical 0 Hazardous locations. ❑Supply voltage for more than El Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site:Walnut Street EI6UU n' nescription I Qty, I Each I Total I - New residential single-or multi-family dwelling unit. Subdivision:Walnut Grove Lot#: 13 Includes attached garage. Tax map/parcel 2S103AC0440 1,000 sq.ft.or less 168.54 4 Ea.add'I 500 sq.ft.or portion 33.92 1 Limited energy,residential 75.00 2 Rerouting electrical due to new door installation (with above sq.ft.) Limited energy,multi-family 75.00 2 Installation of exterior outlet operated by switch residential with above ft Renewable Energy ❑ See Page 2 Services or feeders installation,alteration and/or relocation Name:Richard Ericksen 200 amps or less 100.70 2 Address: 12567 SW 114th Ter 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP:Tigard,OR 97223 601 amps to 1,000 amps 301.04 2 Phone:(503)504-3017 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,ren r exc efc— 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 7-- Branch circuits-new,alteration,or extension,per panel P00 A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit Contact name:Richard Ericksen B.Fee for branch circuits without 114th service or feeder fee,first Address: 12567 SW 114 Ter branch circuit 56.18 2 City/State/ZIP:Tigard,OR 97223 Each add'I branch circuit 1 1 7.42 2 Miscellaneous(service or feeder not included Phone:(5503)504-3017 Fax: Each manufactured or modular 67.84 2 Email: richericksen@gmaii.com dwelling,service and/or feeder Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 Business name:Self Sign or outline lighting 67.84 2 Address: Signal circuit(s)or limited-energy 0 See Page 2 2 panel,alteration,or extension. I City/State/ZIP: Each additional inspection over allowable in any f the above Additional inspection(I hr min) 66.25/hr Phone: Fax: Investigation(I 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.: Tsuprv.Lic.: specifica I IIX li I s.ted`(V2 hr min) Suprv.Electrician signature,required: Tgk(" PERMIT *08 Subtotal: Print name: Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature TOTAL PERMIT FEE: 4"x-9 91- 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. I\Building\Permits\E"C-Per�mitApp_ELR_EPE.dm Rev 06/17/2015 440-4615T(11/05/COM/WEB 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 12567 SW 114TH TER, TIGARD, OR, 97223 Residential - Electrical 199 Electrical ﬁnal PASS - No C of O ELC2016-00051 Herb Stabenow Violation Summary: Inspector Contractor