Permit (84) CITY OF TIGARD ELECTRICAL PERMIT
3, COMMUNITY DEVELOPMENT Permit#: ELC2016 00250
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/31/2016
Parcel: 1 S136CB05300
Jurisdiction: Tigard
Site address: 10980 SW 83RD AVE
Project: Heath Subdivision: STEVE&HUGHIE'S PLACE Lot: 25
Project Description: (2)branch circuits for heat pump hook up.
Contractor: NORMANDIN ELECTRIC Owner: HEATH, JOSHUA M
51086 NW CLAPSHAW HILL RD HILL, NATALIE
FOREST GROVE, OR 97116 10980 SW 83RD AVE
TIGARD, OR 97223
P
PHONE: 707-481-7318
HONE: 503-357-5380
FAX: 503-357-4878
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 03/31/2016 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/31/2016 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 for more the 180
days. ATTENTION: Oregon 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 R 952-001-0090. Y btain a .. . .. .es or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344•
Issued 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' 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 1 t 1 R 01 1 1( 1 1 .1 0v 1 1
City of Tigard
Received
1 111 o u..13125 S W Hall Blvd.,Tigard OR 97223 �`�� PlatRBy 3 '3 6 /6 Permit#: q v t(D` .� r .0
! Phone: 503.718.2439 Fax: 503.5 ePlan Review
�
Date/By: /y� �^
Inspection Line: 503.639.4175 ^ /_ ' - 75
-
Inspection
'IQ See Ready at eBy: See Page 2 for
I i i, \is l Internet: www.tigard-or.gov
3 7 I
1� �� 'hit ♦�Q , 3 til ,,tri amental Information
TYPE OF WORDG\\11
P �4 PLANA, tE lfvIEW/ll Ih
❑New construction ®Addition/altemtia,`` `V+�' Please check all that ap t checked):
❑Demolition ❑Other: 1J�`O\ 0 Service or feeder ee stories.
where the availabl
and
CATEGORY OF CONDUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
Irl-and 2-family dwelling ❑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 0 Other:
0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION �) 0 Emergency system. larger separately derived
Job#: Job site address: /Del t 1) 50 , 5rd �,t„p 0 Addition of new motor load of system.
/�j J 100HP or more. ❑"A",••E„ "1.2" "1.3"
City/State/ZIP: ❑Six or more residential units. upancy.
■�� 97� 0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.4: IPProject name: 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
Descripdoe I Qty. I Each 1 Teal I •
New residential Subdivision: Lot 4: Includes attached garage le-or multi-family dwelling unit.
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 en '
ergy,residential 75.00 2
Hr
1 ,P�p / ve , I rP^ (with above sq.ft.)
I.[t�C� �J f L�(�J Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
0 PROPERTY OWNER 0 Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: jO5ti 4., N '4,ihG Heath 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 ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first / 56.18 f� /
branch circuit
City/State/ZIP: Each add'I branch circuit 1 7.42 '7,4
Phone: Miscellaneous(service or feeder not included) //
( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: /�/��cly3 , Sign or outline lighting 67.84 2
�� s L `/ t Signal t(s)or limited-energy ❑ Page 2 2
Address: i Etc/ panel,alteration,or extension.
City/State/ZIP: -/ 7j�/ 6 7711lo Each additional inspection over allowable in any of the above
(ff 1,355 7-
��') (Q/3 '7 4(7?
( I ve;tio�inspection()hr min) 66.25/hr
Phone: Fax: .� Investion(1 hr min 90.00/hr
�
, Industrial plant(1 hr min) 78.18/hr
EmaiL:A/ a Ori 5-7 61 /pASW;''�r��, Inspections for which no fee is
90.00/hr
CCB Lic.:.b /i r Electrical Lic 6 L.,Suprv.Lie:15331i,� , s���h'listed(4 hr min)
J ELECTRICAL PERMIT FEES // TT
Suprv.Electrician signature,required: Subtotal: �Li, b(/
r ' /
Print named �� Hifi./
Date. fij�j ❑Plan Review Required(25%of permit fee): : 7 / ?
J i fl State surcharge(12%of permit fee): f�J
TOTAL PERMIT FEE: 71 z3.,
Authorized signature:
Thh permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I.\Building\Pe nits\ELC PennitApp_ELR_ERE.doc Rev 06/17,2015 440.4615T(I lro5/COM/WEB
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
10980 SW 83RD AVE, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00250
Chip Barnett
Previous corrections have been completed
Violation Summary:
Inspector Contractor