Permit n CITY OF TIGARD ELECTRICAL PERMIT
t • COMMUNITY DEVELOPMENT Permit#: ELC2016-00237
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/28/2016
Parcel: 2S110DD00109
Jurisdiction: Tigard
Site address: 11005 SW SUMMERFIELD DR 8
Project: Summerfield Subdivision: WILLOW-BROOK-FARM Lot: 15
Project Description: (1)branch circuit for dryer vent in upperr unit.
Contractor: MCCAMMON ELECTRIC CORP Owner: SUMMERFIELD ASSOCIATES, LLC
5086 IKE MOONEY RD BY HSC REAL ESTATE
SILVERTON, OR 97381 1500 SW FIRST AVE STE 1020
PORTLAND, OR 97201
PHONE: 503-559-8466 PHONE.
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 03/28/2016 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/28/2016 $6.74
Type of Use: MF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports(Conditions)
This permit is iss.•. 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 accordance wi approved plans. This permit will expire if work is not started within 180 days uance, or if work is suspended for more the 180
days. TENTION: Oregon law quire you to follow the rules adopted by the Oregon Utility N fication Cent . Those rules are set forth in OAR
952-r.1-0010 through OAR 952- 01-0090 Yo may obtain a copy of the rules or direct questions to OUNC by calli g 503.231 .198 or 1.800.33 344.
Is ued By: Permittee Signature:
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' - _ f�, Date:c.......5/,54740
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 FOR t)FFIt 1. I st:ONI 1
City of Tigard �E�EIVE® Received — nUOn
�1&—
UPIDate/B (9- 11P Permit#: L� �c2,37
13125 SW Hall Blvd.,Tigar ,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.5Q t(i 8 2 16 Date/B : Related Permit#: Z(p-OO y
Inspection Line: 503.639.4175 WWII Ready Date/By: Juris: ® See Page 2 for
IR, 1 1:1 t Internet: www.tigard-or.govOC TIGA�aBD s► Notified/Method: Supplemental Information
TY QNiSION PLAN REVIEW
❑New construction IS Addi ton/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.
0 Demolition El Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION 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 ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
M� e /� ❑Addition of new motor load of system.
Job#: Job site address:
I' OW lwJ� ce� I i7 .POZ., 1001IP or more.
City/State/ZIP: / �j ❑Six or more residential units. occupancy.
y r�Y'/� 4 f 72 2� ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: f Project name: L4-1 fNL. C(R -C U) 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: .4)t)2p ig fl, FEE SCHEDULE.
Description I Qt?. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision:10mm r--02F/LLn Lot#: includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add]500 sqa or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
.r� ♦ 75.00
D OEP)c pl T6- Cf/Z C V/7 -6)2 jy& UM (with above sq.ft.)
�T �� Limited energy,multi-family
residential(with above sq.II.) 75.00 2
Renewable Energy 0 See Page 2
V PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name:comkierg Fi621JsOc{,¢-7&--5;
(.LC 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
r
Address: 1 I 1 7C S)-✓ /i'it of o iBocOoK P4 401 amps to 600 amps 200.34 2
City/State/ZIP: 77 .b 6I / 7 2 2 / 601 amps to 1,000 amps 301.04 2
Phone:(3-v3) 66 Li_ /gq/ Fax:( ) _ Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:IVA/Meg F&ZOO/2M 4746V 6!/ZE/t!SV9'Z / Co M 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
rif APPLICANT I0 CONTACT PERSON
Branch circuits-new,alteration,or extension,per panel
!,� .- A.Fee for branch circuits with7V�
Business name: MC. � /►'1 V N . l.&•—cTi2(C /r/(, above service or feeder fee,
7.42
w�/ GSMM 0 / each branch circuit
Contact name: PA_vi( D M C 13.Fee for branch circuits without i /q
Address: �6� / D (/ service or feeder fee,first
I /
branch circuit
56.18 2
City/State/ZiP:$I_102-Tp-r/ C542- q 7 3 e/ Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(crj3) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: S E Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:
Inspections for which no fee is 90.00/hr
CCB Lic.:/L f/Z9 v Electrical Lie.: ZS Suprv. Lic.i/Z.g4,5 specifically listed('A hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: _0-'1,nA Subtotal: yep.
-
Print name: 3 fctw• S Date: 3...-25-._/ 4 0 Plan Review Required(25%of pennit fee):
r
State surcharge(12%of permit fee): e0. 7
Lc
Authorized signatur : id,t7 � TOTAL PERMIT FEE: a _.?9—
.� This permit application expires if a permit is not obtained within 180
Print name: I )l�V rc: Date: 32,516 days after it has been accepted as complete.
J a 444 * Number of inspections allowed per permit.
I:Building Permits EEC PermitApp ELR ERE.doc Res 0617 2015 440-46151(11 05 COM WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
001004TIAL WORKNLY: h F FEE SC1✓
Description I Qt I 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
with OAR 918-309-0040) 552.26 2
n Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
I] Vacuum Systems* >100 kva no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
El 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('/hr min)
COMMERCIAL WOR ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I):
Fee for each commercial system: $75.00
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ D• ata Telecommunication Installation
❑ F• ire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I Building Permits GLC PermiiApp FI R_ERF.doc Rem 06 I?2015