Permit (85) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016-00149
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/29/2016
Parcel: 2S102DB00203
Jurisdiction: Tigard
Site address: 9303 SW HILL ST
Project: Neubo Subdivision: BURNHAM TRACT Lot: 7
Project Description: Electrical reconnect only
Contractor: N/A Owner: CRAIG&KRISTY NEUBO
18418 OLD RIVER LANDING
LAKE OSWEGO, OR 9
PHONE:
PHONE: 503-305-6001
FAX:
FEES
Quantity Description Date Amount
Specifics: 1 ea Reconnect Only 02/29/2016 $67.84
1 ea 12%State Surcharge- 02/29/2016 $8.14
Electrical
Type of Use: SF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
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 fo more the 180
days. ATTENTIO on law requires you to follow the rules adopted by the Oregon Utility No
tificati n ter. Those rules set forth in OAR
952-001-0010 rough OAR 2-0 90. ou may obtain a copy of the rules or direct questions to OUNC by calling 503. .
1 1. 32 34
Issuedy: —L42 Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property 1 own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' /VM— 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 .�^/
City of Tigard Permit#: e —0Ol g
13125 SW Hall Blvd.,Tigard,OR 972 ^''� DateB : 14 O�
a g �,,,/L'� ` Plan Review Related Permit#:
Phone: 503.718.2439 Fax: 503.598.1960 ww°° Date/By:
Inspection Line: 503.639.4175 Ready Date/By: Juris: ® See Page 2 for
Internet: www.tiard-or. ov
g g FEB 2 9 2016 1 Notified/Method: Supplemental Information
New construction ` Please check all that apply(submit 2 sets of plans w/items checked):
❑ ❑Addition/altt>)Q�i/ }}t t
'.��i N ❑Service or feeder 400 amps or more ❑Building over three stories
❑Demolition ®Other:turn on electri where the available fault current ❑Marinas and boatyards.
� c fix. .` CICEGOR ;'OF�iSTf)1fllT�N 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
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
w x
❑Emergency system. larger separately derived
Job#: Job site address: -930 ill Street ❑Addition of new motor load of system.
I00HP or more. ❑"A" "E" "I-2" "1-3"
Oregon Cit /State/ZIP:Tigard Ore 97223 ❑Six or more residential units. occupancy.
ClHealthcare facilities.
y g g [3Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Neubo ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions tojob site:
Description I Qty. I Each Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1
im. 'b CR1PT(lily U1� WO1t1C k .x
•" ��„ .-.x�t Limited energy,residential 75.00 2
Electricity has been off for more than 6 months-inspect to have PGE turn on with above .ft.) -
Limited energy,multi-family 75.00 2
electricity. residential with above sq.ft.)
Renewable Energy ❑ See Page 2
fila' -��PROPERTV OWNER :� ,', . [ = 1 TA1!fC,` Services or feeders installation,alteration,and/or relocation
Name:Craig and Kristy Neubo 200 amps or less 100.70 2
Address: 18418 Old River Landing 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Lake Oswego OR 97034 601 amps to 1,000 amps 301.04 2
Phone:(503)305-6001 Fax:(503)305-6002 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
�.
�k Branch circuits—new,alteration,or extension, er panel
>APPLtCAI±t .. x (�► r , PER OI�t 2;
A.Fee for branch circuits with
Business n e: 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 56.18 2
branch circuit
City/State/ZIP: c 4 lj Z1,41 Each add'I branch circuit 7.42 2
/ Miscellaneous serycl
ice or feeder not inuded
Phone:( l7�) 305-(p GQ Fax: :( 03) 365 -606 Z- Each manufactured or modular 67.84 2
y ,, �, c' e and/or feeder
Email: cA54' t At4 Reconnect onl 67.84 2
a ^` �
;f .r €: _ �M=� Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy
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(I hr min) 78.181 hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed %:hr min
Suprv.Electrician signature,req fired: Subtotal:
Print name: Date: ❑Plan Review Required(25%of permit fee)`. �—
State surcharge(12%of permit fee): g•
Authorized sign ure:
TOTAL PERMIT FEE: 76'
_ This permit application expires if a permit is not obtained within 180
Print name: j1 4AAb a Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
11Building\Permits\ELC_PermitApp_E EREAoc Rev 06/17/2015 44 615T(II 5/COMMEB
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
9303 SW HILL ST, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00149
Herb Stabenow
Reconnect only
Violation Summary:
Inspector Contractor