Permit (17) CITY OF TIGARD ELECTRICAL PERMIT
`11 ' - COMMUNITY DEVELOPMENT
; Permit#: ELC2016-00191
T 1GARCD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/14/2016
Parcel: 2S111AD05700
Jurisdiction: Tigard
Site address: 8710 SW PINEBROOK ST
Project: Low Subdivision: PINEBROOK TERRACE Lot: 80
Project Description: Permitting previous panel installation without permit.
Contractor: OWEN WEST ELECTRIC Owner: LOW, CHRISTOPHER G&CAITLIN R
8310 NW REED DR 1905 NW 29TH AVE,APT 206
PORTLAND, OR 97229 PORTLAND, OR 97210
PHONE: 503-297-6375 PHONE:
FAX: 503-297-6375
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 03/14/2016 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 03/14/2016 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 • • e.• - 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, ENTION: Orego 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 r' -00'0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19871.800.332.2344. �
/
Is-ued By: / i� Permittee Signature: V
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' X ���� � Date:
LICENSE NO. /` x— aggS 5
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 Applica> ECEIVED F(llz(>FFI( I: 1 SF: (>,,1.N
City of Tigard Permit 4: i:L�db!!P-00/9�
w 13125 SW Hall Blvd.,Tigard,OR AMR 1 4 2016 Date/B
Received
Plan Review
IIPII Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175 CITY OF TIGARD Ready Date/By: loris: ® See Page 2 for
116.\1:1) Internet: www.ti ard-or. ov Notified/Method: Supplemental Information
g g ILDING DIVISION pp
E OF WORK PLAN REVIEW
❑New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Dem ' Ion ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 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
S;)
0 Addition of new motor load of system.
Job#: Job site address: 3 1 t 0 S i.� e i I7 e h ri d n t� l0OHP or more. ❑ A","E",'t-z' l-3",
City/State/ZIP: ❑Six or more residential units. occupancy.
ty ' 9 6,r 4 f O R .77 v.-4- Tr 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: LOGO 0 Hazardous locations. 0 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
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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
�j
a (with above sq.ft.) 75.00 2
Ae C. r eye (I—To S y - P4 r e'l` 1..-7.--r .„ Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: (/'/r i 5. )...,0 w 200 amps or less / 100.70 /06,7e. 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
Branch circuits-new,alteration,or extension,per panel
0 APPLICANT 0 CONTACT PERSON A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first
Address: branch circuit 56.18 2
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Ow e il •1.) sT ' ' 1 'e-c__1- Signor outline lighting 67.84 - . 2
Signal circuit(s)or limited-energy
Address: 6' ',a /j/ .(,J' fri . i' P R panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: p 0 y."T ckH a D R Ci 7 r Each additional inspection over allowable in any of the above
( Additional inspection(1 hr min) 66.25/hr
Phone:(5(0) a.7 ('e 3 7 C Fax:( ) S q LA e..... Investigation(1 hr min) , 66.25/hr
Email: 7 / Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.:1...q4..? Electrical Lic.: 9.4, . 3`f 8'_C Suprv.Lic.: 2S, 5 s specifically listed(%z hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
Subtotal: /OD.70
Print name: A D E.> L in u.e; Date:' -i i. _) 4, ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): /A-°t
TOTAL PERMIT FEE: //7+•7 T
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: ,..e...P L% _ Date: —Olt-- / Lj days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELRERE.docx Rev 04/21/2014 440-4615T(11/05/COM/WEB 157.17-
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. I Each I Total
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 over25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ 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(%2 hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONLY:
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
y * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
❑l Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I.\Building\Permits\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014
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
8710 SW PINEBROOK ST, TIGARD, OR, 97224
Residential - Electrical
115 Electrical service
PASS
ELC2016-00191
Herb Stabenow
Violation Summary:
Inspector Contractor
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
8710 SW PINEBROOK ST, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00191
Herb Stabenow
Violation Summary:
Inspector Contractor