Permit (32) CITY OF TIGARD ELECTRICAL PERMIT
• • COMMUNITY DEVELOPMENT Permit*: ELC2016-00346
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/27/2016
Tl�''� I<.Dg Parcel: 2S104AD04400
Jurisdiction: Tigard
Site address: 12520 SW WALNUT ST
Project: Isaacson Subdivision: None Lot: None
Project Description: Install(2)ground rods due to new water service.
Contractor: METRO ELECTRIC INC Owner: ISAACSON, GARLA E
3860 SE PELTON AVE 12520 SW WALNUT ST
TROUTDALE, OR 97060 TIGARD, OR 97223
PHONE: 503-666-2154 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 04/27/2016 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 04/27/2016 $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 i . •r.an with approved plans. This permit will expire if work is not started within 180 days of issuance, or if w'rk is suspended for more the 180
days. TENTION: Oreg• I. re uires you to follow the rules adopted by the Oregon Utility Notification Ce -r. % ose rules are set forth in OAR
952-041-0010 through OAR 9-•-001-00^0 You may obtain a copy of the rules or direct questions to OUNC by calling 503. 32. f 0' 32.2344.
Is�ued By: , � �� Permittee Signature: K' , wilf
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
11
SIGNATURE OF SUPR.ELEC' total % Date: 4//7/6
I —
LICENSE NO. 50'7 7S
Call 5' .639.4175 by 7:00 a.m.for the next available inspection date.
This permit card sha 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 ()um I L I ()NI.)
City of Tigard Received
13125 SW Hall Blvd.,Tigard,OR 97223 Date/B : i �� ` Permit#: • ��� '�
g Plan Review
111 Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#: pu-t?-i n 6.—6O
Inspection Line: 503.639.4175 Ready Date/By: Juris: ® See Page 2 for
I It,A R 1) Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE`,OF WORK PLAN REVIEW
❑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.
El Demolition El Other:
where the available fault current 0 Marinas and boatyards.
. CATOORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
211-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 0 Other: ❑Fireum
p p. 0 Installation of 150 KVA or
JOB SITE INANIMATION AND;LOCATION 0 Emergency system. larger separately derived
[[' /� ❑Addition of new motor load of system.
Job#: Job Site address:
(A) (, \y c\ KT-- I00HP or more. ❑„A„ "E,. ..l 2„ .,13„
��
City/State/ZIP: `��f
El Six or more residential units. occupancy.
`�(y'ul...0 CI'(L(° 11 ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: /� A.) ❑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 j 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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF-WORK Limited energy,residential
f (with above sq.ft.) 75.00 2
�vx r v S neU..) Limited energy,multi-family
2
residential(with above sq.ft.) 75.00
CO c?\ Ce_ Renewable Energy ❑ See Page 2
a PROPERTY OWNER ❑ 'TE.NAI' . Services or feeders installation,alteration,and/or relocation
Name: / -�1(J e-� 200 amps or less
Address: 6 201 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
Q APPLICANT 1 0 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 �,,1
branch circuit 56.18 S r 2
Each add'(branch circuit 7.42 7. y 2
City/State/ZIP: �
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 2
CONTRACTORt Pump or irrigation circle 67.84 2
Business name: c•d-6 b--,,, r
4 v e5 Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 3 P_)(1) 5 E -°e= \ e panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: �- Q vC Each additional inspection over allowable in any of the above
�� `7 7c6 0 Additional inspection(I hr min) 66.25/hr
Phone:(50-,) 6,C A.(S 9. Fax:( ) Investigation(1 hr min) 90.00/hr
L�' � n/`� Industrial plant(I hr min) 78.18/hr
Email:i� T Ito 'eGTN Wt
-,G gV O GoC� 1- - +P^1- r• Inspections for which no fee is
90.00/hr
CCB Lie.: / '60 5-- Electrical Lie.: Suprv. Lic.: LI-7 s specifically listed(%hr min)
,/i� ELECTRICAL PERMIT FEES ,.Suprv. Electrician signature,required: /// Subtotal: KyarU
/ t
Print name: /Li n 1'3 )% As O Date: >A0,,,... 42,
❑Plan Review Required(25%of permit fee):
jj,keState surcharge(12%of permit fee): j.
Authorized signature: TOTAL PERMIT FEE: V 7/. 9-3
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.
1:Building Permits ETC,PennitApp_ELR_ERE.doc Res 06 17 2015 440-4615T(11,05COMWEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
:IftOWE$T Wfl i ,01L.Y, �. . }
Description Qty Each 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
n 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:
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(h hr min)
O ERC WORK ONLY: 10 c t E�
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
y * 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
El Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I BuildingPermits ELC_PermitApp_ELR ERE.doc Res 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
12520 SW WALNUT ST, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00346
Jeff Grove
Violation Summary:
Inspector Contractor