Permit (95) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016-00366
Date Issued: 05/05/2016
Tit„;A R T7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1S135CC03300
Jurisdiction: Tigard
Site address: 10050 SW TIGARD ST
Project: Gray Subdivision: GREENBURG HEIGHTS ADDITION Lot: 11
Project Description: (1)200 amp service and(4)branch circuits for moved SF home,
Contractor: P. DICKINSON ELECTRIC Owner: CSC CAP HOLDING LLC
20719 SW LIDO CT. BY GRAY,TIMOTHY
ALOHA, OR 97078 22846 SW LODGEPOLE AVE
TUALATIN, OR 97062
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 05/05/2016 $100.70
Specifics: amps or less
4 crt Branch Circuits w/Purchase 05/05/2016 $29.68
Type of Use: SF Service or Feeder
Class of Work: OTR 1 ea 12%State Surcharge- 05/05/2016 $15.65
Electrical
Type of Const: VB
Occupancy Grp: R-3
Total $146.03
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 OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 11
4 A j// 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:
/ /CONTRAC INSTALLATION ONLY r
SIGNATURE OF SUPR.ELEC' Date: J b
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 Foil 014 1( 1. t SI: ONI.v
City of Tigard Received
Date/B : j "'6 . r
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
'; • Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
inspection Line: 503.639.4175 Ready Date/By: loris: ® See Page 2 for
I I i..A RI) Internet: www.tigard-or.gov Notified/Method: Supplemental information
TYPE OF' WORK PLAN REVl
❑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.
❑Demolition ❑Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
�l-and 2-family dwelling ❑Commercial/industrial El Accessory building
less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 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
❑Addition of new motor load of system.
Job#: Job site address:
look) S -r y c 64, l0OHP or more. ❑"A" "E" "l-2" "1-3
occupancy.
q ❑Six or more residential units.
City/State/ZIP: T ;104-)j / 0( /-7�� 0Recreational vehicle parks.
0 Health-care facilities.
Suite/bldg./apt.#: Project 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
Description I Qty. I Each I 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'!500 sq.ft or portion 33.92 1
DESCRIPTION OP WOR ( Limited energy,residential
�� �C r)a at \ "up (with above sq.ft.) 75.00 2
fv P Most a..-t� t v•res -�� ^..... 4SC 40 r V;c Limited energy,gry,multi-farnily 75.00 2
A-a) O;VCIAZ}-jSw:4h1 % e'Q. il'actozsfoca.v Aga �Ce$s't 1kk5 residential(with above sq.ft.)
J Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER ' 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
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 i
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 ❑ OIVTATrots9N A.BranchFeefor circuitsbranch—ccircuits new,alteration,with or extension,per panel
. .
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 2
branch circuit
City/State/ZIP: Each add'!branch circuit 7.42 Li 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
Email: dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTORPump or irrigation circle 67.84 2
Business name: P, ''cis I h SD V1 t-t e cEx.` o(/ Sign or outline lighting 67.84 2
' Signal circuit(s)or limited-energy
Address: A07/9 S w L t a O e4 0 See Page 2 2
panel,alteration,or extension.
City/State/ZiP: At o l ex (2g q 7 07 a Each additional inspection over allowable in any of the above
/ Additional inspection(1 hr min) 66.25/hr
Phone:(5-1.).3) 7y0 6/o 0 Fax:( )) Investigation(1 hr min) 90.00/hr
Email: P g-e"c� -[k.. 5e Vt 5 .el e,C 1 SC'S C .c O Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
90.00/hr
CCB Lic.:a0� Electrical Lie.: Su. . Lie b��►L� specifically listed(Yz hr min)
ELECTRICAL PERMIT PEES
Suprv. Electrician signature,required: Subtotal:
Print name: i36-.e,(- i c•k; iv SOVI,. Date: 5.-5—--?tCil 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
TOTAL PERMIT FEE: W(G
Authorized signature: fj.Q3
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.
L,.Building'.Permits`ELC_PermitApp_ELR_ERE.doc Rev 06 172015 440-4615T(11,05'COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
70.0"0r @ � �". ty�x 'r. `r ,.- r ti...5 .� `�t. *,ah a,',, a ++*.>.,:� & P r ;am.i`.; �, :
Fee for all residential systems combined: $75.00 Description t Qty Each Total (`
3' 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 over 25 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 CA hr min)
COMMERCIAL'WORKONLY•
Subtotal(Enter on Page 1):ELECTRICAL,PIERMI FEES
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
❑ 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
1Building PermitsELC_PermitApp_ELR_ERE.doc Rex 06 172015
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
10050 SW TIGARD ST, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00366
Jeff Grove
Violation Summary:
Inspector Contractor