Permit (15) CITY OF TIGARD ELECTRICAL PERMIT
11111 COMMUNITY DEVELOPMENT Permit#: ELC2016-00203
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/16/2016
Parcel: 2S110DD13700
Jurisdiction: Tigard
Site address: 15505 SW 109TH AVE
Project: SKILLERN Subdivision: SUMMERFIELD NO.14 Lot: 707
Project Description: (3)branch circuits for remodel.
Contractor: SIMPSON ELECTRICAL CONSTRUCTION Owner: SKILLERN, JOHN
2145 NE MCDONALD LN#C 15505 SW 109TH AVE
MCMINNVILLE, OR 97128 TIGARD, OR 97224
PHONE: 503-472-2530 PHONE:
FAX: 503-435-0157
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 03/16/2016 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/16/2016 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty od and II other applicablefaw. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of is- a e, or i work is suspended for o the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificatio enter. Those rules are ct forth in OAR
952-001-0010 through OAR 952-001-0090. You ma obtain a coon of the rules or direct questions to OUNC by calling 503.2:2 1987 or .800.3 . .
Issued By: ��.fi,�• ��— Pefmittee Signature:
Y �
' OWNER INSTALLATION 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 i...,-cliStVI OR Ohl 1( l: t S I: 0\1.1
' Received
1111 City of Tigard Date/B : jJ�/ • •
13125 SW Hall Blvd.,Tigard,OR NI72 o�6 Plan Review Related Permit 8:
Phone: 503.718.2439 Fax: 503.598.1960 ‘c3 Date/B
Inspection Line: 503.639.4175 Mp� Q �0 Ready Date/By: ® See Page 2 for
I I 'si:I) Internet: www.tigard-or.gov V‘6„
�6t (� Notified/Method: _ Supplemental Information
a
�1
OF WO 1. X10),. PLAN REVIEW
0 New construction Addition/alterativ ent Please check all that apply(submit 2 sets of plans w/items checked):
Q 0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition ❑Other: V where the available fault current 0 Marinas and boatyards.
CATEGilt OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
�nd 2-family dwelling D Commercial/industrial 0 Accessory building
less to ground,or exceeds 14.000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: ['Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: t5Soc Job site address: 15505 SW log All . 100HP or more. ❑"A "E "I-2",
��^ ❑Six or more residential units. occupancy.
City/State/ZIP: `� %7 v�C( 0 Recreational vehicle parks.
\ ) 0 Health-care facilities.
Suite/bldg./apt.#: Project name: t!(i(.1 I+�� 0 Hazardous locations. 0 Supply voltage for more than
0 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 1 *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00
CC -- 1 (with above sq.ft.)
YtkR-106
AS 4 Ciattt11L_TEino0EL '�fe"s. Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
❑ PROPERTY OWNER I ` 0 TENANT
Services or feeders installation,alteration,and/or relocation
Name: wrYV Sill I!e, yx/ 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
0
APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: 5i wysi;,1 El,,,,,t:rp 1'hbg_. /l;A/1r , above service or feeder fee,
7.42 l each branch circuit
Contact name: I/ j .J SI Alp ,� B.Fee for branch circuits without
Address: 4/3o NF H,i .0 l cR-EL. '? J branservche it feeder fee,first 56.18 �/ 2
v n `_ t�+-� Fs9 branch circuit S b (�
City/State/ZIP: AlLlr'lln/I,JVIu,E OR c j i Each add'l branch circuit t)— 7.42 7 Lj'A 2
°
Phone: ^'YtJ "7 Fax: :( ) Miscellaneous(service or feeder not included)
(sa 5�(,y Each manufactured or modular
67.84 2
Email: ( dwelling,service and/or feeder
i1mlos0,3Ec.6cra111 i' 6,� 2
Reconnect only 67.84
CONTRA-TT R Pump or irrigation circle 67.84 2
Business name: GS7;' _r ao,_
Cc‘I belieSign or outline lighting 67.84 2
Signal circuit(s)or limited-energy'
Address: ❑ See Page 2
panel,alteration,or extension.
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: "AV/7 7/i / 7 /0///ii, Industrial plant(1 hr min) 78.18/hr
```���%%% Inspections for which no fee is 90.00/hr
CCB Lie.: o Electrical Lic,: Suprv. Lie.: specifically listed(Y hr min)
d� P
133 �� 3!0 � S �3 5
ELECTRICAL;PERMIT FEES
Suprv. Electrician signature,required: C� ^ �"� Subtotal: 1P '�/. i;,2
Print name: t ij SI 6i / Date: 3-1C., —/k, El Plan Review Required(25%of permit fee): F
�` State surcharge(12%of permit fee): , t) • S)
Authorized signature: TOTAL PERMIT FEE: ?cj.
This permit application expires if a permit is not obtained within 18
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:Building Permits FCC PermitApp ELR ERF.doc Res 06 172015 440-46151(11 05('OM WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
S
R�IREN't'IAL WORKWORKONLY;a �, . ' FEE �?:ILE
Description � Qtr 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 100.70 2
5.01 to 15 kva 133.56 2
❑ 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
552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100kva-noadditional charge 0.0 3
Each additional inspection over allowable in any of the above:
n 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: RICAL PERMIT FEES
Fee for each commercial system: $75.00
Subtotal
on Page 1):
* Number of inspections allowed perr perm permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
H Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
H Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1 Building Permits FL(' PermitApp ELR_t RE.doc Res 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
15505 SW 109TH AVE, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00203
Jeff Grove
Violation Summary:
Inspector Contractor