Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016-00324
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/19/2016
TfC�AI=.L� g
Parcel: 1S125DC05900
Jurisdiction: Tigard
Site address: 9640 SW SHADY PL
Project: USA SECRETARY OF HOUSING&URBAN DEVELOF Subdivision: ASH CREEK GATES Lot: 1
Project Description: Reconnect only.
Contractor: Owner: USA SECRETARY OF HOUSING&URBAN DEVE
1220 SW THIRD AVE, STE 400
PORTLAND, OR 97204
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 04/19/2016 $67.84
Specifics: 1 ea 12%State Surcharge- 04/19/2016 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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_aajpted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through• - 952-001-0090. You . •• . • o e rules or• ect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
�- � c;
Issued By: Lim _ Permittee Signature: • - -2<
_i
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 503.639.4176 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 1.08 0[1.1( I I Sl:O\l l
rtNCity of TigardVilVt. Received
13125 SW Hall Blvd.,Tigard,OR ' Plan Review
'1 s Phone: 503.718.2439 Fax: 503.5'ti. '60 016 Date/B : Related Permit#:
Inspection Line: 503.639.4175 % ' Ready Date/By: kris: RI See Page 2 for
I Ii. :11:1) Internet: www.tigard-or.gov \C)% 0`0 Notified/Method: '7:: * Supplemental Information
CI
TYPE OF WOR �� t1��1�1` PLAN REVIEW
❑New construction ❑Addition/alteratron s .••� ,• 10.1Please check all that apply(submit 2 sets of plans w/items checked):
( t ❑Service or feeder 400 amps or more 0 Building over three stories.
ElDemolition Other: �j { 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 ❑Commercial/industrial El Accessory building less to ground,or exceeds 14,000 ❑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: C1(014 6e w'S``, pt�C ❑Addition of new motor load of system.
J l I OOHP or more. ❑"A.....E..,..1_Z,-,„1_�..
��
0 Six or more residential units, occupancy.
City/State/ZIP: 1 l y-,4y-,4t Ok %/��a'al 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 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 1 Total I *
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 sqftor portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
^7- (with above sq.ft.)
Ei«t r,r CnN Ne l LNil n,. Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
I PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: C(154 4/-_F� r �* �,(e �_„„ .� 200 amps or less 100.70 2
� LTJ! L ] //V � "V�JCdA/ LCd.ec�i` %17G/�Jt
Address: W / it>�t /��y� 201 amps to 400 amps 133.56 2
I tCV 401 amps to 600 amps 200.34 2
City/State/ZIP: Do�l G�7 � 601 amps to 1,000 amps 301.04 2
Phone:( ) t� 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 exslettge,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
!( ��// r 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 41 2
eacE�W c4 K 1 Fee obr nch circuit
Contact name: �eJ�F B.Fee for branch circuits without
n service or feeder fee,first
Address:
-Z(/O SL5 Cot °" 'tl ot branch circuit 56.18 _
City/State/ZIP: PeTi1 OY5 q V(Ci, Each addI branch circuit 7.42 2
l "( / I Miscellaneous(service or feeder not included)
Phone:(.En ) -i.,10,_1 o-' Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: ( I,tiyk e 6,........q.zap pi Reconnect only ( 67.84 (7 2
CONTRACTOR Pump or irrigation circle 67.84 ll 2
Business name: 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 Lie.: Electrical Lic.: Suprv. Lie.: specifically listed('/z hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal: 6 7. rt
Print name: I Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): g',PI
Authorized signature: TOTAL PERMIT FEE: �s en
This 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 Permits ELC_PermitApp_ELR_ERE doe Res 06 17 2015 40-46151(11 05 COM WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
til` "IAt1""f ' 3R :O LY : .. . 'SE �5 u :>?
Description I Qty. 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
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
n 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
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(Y:hr min)
COMMERCIAL WORK ONLY: .ECTRICAu PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page I):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
H Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n 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 Permi=App ELR_ERE.doe Re,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
9640 SW SHADY PL, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00324
Jeff Grove
Violation Summary:
Inspector Contractor