Permit (37) CITY OF TIGARD ELECTRICAL PERMIT
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g ° COMMUNITY DEVELOPMENT Permit#: ELC2016-00224
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/23/2016
Parcel: 25111 CB00500
Jurisdiction: Tigard
Site address: 14805 SW 103RD AVE
Project: MUNHALL Subdivision: DEL MONTE SUBDIVISION Lot: 4
Project Description: Extension of(1)branch circuit for lighting.
Contractor: ROCKY MOUNTAIN ELECTRIC Owner: MUNHALL SURVIVOR'S TRUST
PO BOX 670 BY MUNHALL,JEAN B TR
BORING, OR 97009 14805 SW 103RD AVE
TIGARD, OR 97224
PHONE: 503-618-9379 PHONE:
FAX: 503-663-6619
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 03/23/2016 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/23/2016 $6.74
Type of Use: SF Electrical
Class of Work: ALT 0 Cash Over 03/23/2016 $0.01
Type of Const:
Occupancy Grp:
Total $62.93
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 don accordance . 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 - •• es 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'-009.. .0 may obtain a copy of the rules or direct questions to OUNC b 2.1987 or 1.800.3333322..233444..
Is ed By: - �' // �.d Permittee Signature. � _�,%AM", _�
•
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' ��J Date: ,:74
LICENSE NO. ,/ (53 S
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 Applicata FOR OFFICE l SE ()NIA
City of Tigard E IVED FOR
4� Permit#: ALL► ge)/�Z�O
Date/B :
-Ili • 13125 SW Hall Blvd.,Tigard,OR 9722R 2 3 2016 Plan Review Related Permit 8:
Phone: 503.718 2439 Fax: 503.598.1 Date/13 :
Inspection Line: 503.639.4175
CITY
� t l TIGARD
t R dy Date/By luras: ® See Page 2 for
TIGARD Internet: www.tigard-or.gov ��)+�I�nY�v� i l�lt � Notified/Method: Supplemental Information
PE OF'WQHICNG DIVISION PLAN REVIEVk
❑New constructionAdd ition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more ElBuilding over three stories.
❑Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job site address: ❑Addition of new motor load of system.
Job
I y8 05• s.W `d3rJ A vE . 100HP or more. ❑"A E "1-2" 3"
City/State/ZIP: C�`�j ❑SLC or more residential units. Occupancy.
I `�A4�4• / / 2 ❑Health care facilities.
0 Recreational vehicle parks.
Suite/bldg./apt.4: Project name: K u")414-Li._, 0 Hazardous locations. ❑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 t Total I •
New residential single-or multi-family dwelling unit.
Subdivision: Lot 4: 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 ener
/ .¢-- gy,residential 75.00 2
EX 7j// Of.. AS kr/ob (' 1 c2 c/ / (with above sq. lti
`J / Limited energy,multi-family 75.00 2
residential(with above sq.ft)
0 PROPERTY OWNERRenewable Energy ❑ See Page 2
0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 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
Over 1,000 amps( ) Fax:( ) 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
APPLICANT Branch circuits-new,alteration,or extension, r panel
0 ❑ COSI-[ACI PERSON A Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
rnntort nam,*' u.r cc rv”vrau..0,u,uxt wunvur
service or feeder fee,fir
Address: branch circuit ] 56.18 13°4.
City/State/ZIP: Each add'I branch circuit ii 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 only 67.84
1 CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 4—Poe.�y I/r--�-��• '----L.EIC/ c—
Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: Fc,• x ( 7Q panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: �/yp "1-A) 0���PP Cr 7Dd 9 Each additional inspection over allowable in any of the above
'v` Additional inspection(I hr min) 66.25/hr
Phone:(5 )gf 6_95 Fax:(spa)4.4,- ... 44,1 J 7 Investigation(1 hr min) 90.00/hr
�_ Y cAs,_ w Industrial plant(1 hr min) 78.18/hr
Email: Y-cK L P --O�If n e.27_____
�
tot VIP
Inspections for which no fee is 90.00/hr
CCB Lic.:7-�Z.f a 4%1Electrical Lic.: _-rige_.1 uprv.Lic.: 15' 3 specifically listed(%hr min)
,111 ELECTRICAL PERMIT FEES i,...9
Suprv.Electrician signs re,requires Subtotal: f i . , -
Print name: b e es I AAA use)<- Date2/22,/v,/(o 0 Plan Review Required(25%of permit fee): ��
/ State surcharge(12%of permit fee): Co
Authorized signaturQ kA.. ___. TOTAL PERMIT FEE: to 2.93
This permit application expires if a permit is not obtained within ISO
Print name: fiber O Ouse Date: ZZ��O// days after it has been accepted as complete.
(� • Number of inspections allowed per permit.
1:\Buildfrig\Permits 1ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-46151(11/05/COM/WEB