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Permit CITY OF TIGARD t ',; ELECTRICAL PERMIT 44 11 ''' COMMUNITY DEVELOPMENT / > Permit#: ELC2016-00330 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/21/2016 Parcel: 2S102BC01500 Jurisdiction: Tigard Site address: 10270 SW WALNUT ST Project: TINSLEY Subdivision: NORTH TIGARDVILLE ADDITION Lot: 27 Project Description: Panel replacement. 5/10/16:REPRINTED permit to show change of contractor from owner to American Electric Service. Contractor: AMERICAN ELECTRIC SERVICE Owner: TINSLEY, FRANK&VICKY PO BOX 1057 10270 SW WALNUT ST SHERWOOD, OR 97140 TIGARD, OR 97223 PHONE: 503-537-2121 PHONE: FAX: 503-554-8506 FEES Quantity Description Date Amount 1 ea Services or Feeders-200 04/21/2016 $100.70 Specifics: amps or less 1 ea 12%State Surcharge- 04/21/2016 $12.08 Type of Use: SF Electrical Class of Work: ALT 45 Misc Administration Fee 05/10/2016 $45.00 Type of Const: Occupancy Grp: Total $157.78 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 952-001-0090. You ma ..:in a copy of r direct questions to OUNC by calling 503.232,987 or 1.800.332.2,0;4. M1 Issued By: f.- ••ittee Signature: C--'6) Tf 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. 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 10270 SW WALNUT ST, TIGARD, OR, 97223 Residential - Electrical 199 Electrical ﬁnal PASS - No C of O ELC2016-00330 Jeff Grove Violation Summary: Inspector Contractor City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT r = Request for Permit Action i 1(i A p h 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD RECEIVE Building Division 13125 SW Hall Blvd.,Tigard, OR 97223 MAY 1 0 2016 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermi�� \�RD CII FROM: ❑ Owner pplicant n Contractor AIIDIVISION Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) V ( C_ ( I n 5 e,ti Mailing Address: LCpa 20 -- .1 (A)C'k kNAM v t ^, A City/State/Zip: 1 If er L- 0 9-7 ;- a..-__ PhoneNo.: 5-D3--604,-7e 3 7 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ CANCEL/VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). MOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: E LC 14-- 00330 Site Address or Parcel #: f Q,P,7n S W (Jt1a I h ij Sf -near(' O 9 7a --3 Subdivision Name: Lot #: EXPLANATION: (/1} 0 rK l..) I l � /1?)-1A) b -(2. 41W den') QQ G cx_- C . - c - ' . ,i;w., ��/6 L« 0 ' k ' CZE---T2i .5 V/eC " /9156 ESS 7V /0&72,-,/T Signature: �„ 4(A Date: 5—/ b-1 .) Print Name: Ul.c Ti r e-v 2 Refund Policy 1. The city's Community Development Director,Building Official or City I:ngineer may authorize the refund of: • .Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80'''o of the application or permit fee for issued permits prior to any inspection requests. 2. .All refunds will be returned to the original payer in the form of a check via[S postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OFFICE USE ONLY Route to Sys Admin: Date 57/c /CD By , , Route to Records: Date By Refund Processed: Date J By Invoice Processed: Date By Permit Canceled: Date By Parcel Tag Added: Date By l:ABuilding\Forms\Rc.Peimit.Action_I192314.doc RI CITY OF TIGARD ELECTRICAL PERMIT 11-11 I COMMUNITY DEVELOPMENT Permit#: ELC2016-00330 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/21/2016 Parcel: 2S102BC01500 Jurisdiction: Tigard Site address: 10270 SW WALNUT ST Project: TINSLEY Subdivision: NORTH TIGARDVILLE ADDITION Lot: 27 Project Description: Panel replacement. Contractor: OWNER Owner: TINSLEY, FRANK&VICKY VICKY TINSLEY 10270 SW WALNUT ST 10270 SW WALNUT ST TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503-806-7037 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders-200 04/21/2016 $100.70 Specifics: amps or less 1 ea 12%State Surcharge- 04/21/2016 $12.08 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 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 • •-. e 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. • ENTION: Ore.•n la -tuires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-•.1-0010 through OAR 9 .-001-00•I. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. -11 I-sued By: � i /. a_i4,L _k Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on propertyLe... Om which is not intended for sale,lease or rent. SZ OWNER'S SIGNATURE (C (/ ( 11Date: (,aCONTRACTOR I TALLATION 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 v -, ► OR Oi ► 1( I I 'I O\I \ City of TigardReceived 13125 SW Hall Blvd.,Ti ard,OR 9 Date/B : 1 I — iligPlan Review '� • Phone: 503.718.2439 Fax: 503.5qiCV...4841 Date/B : Related Permit#: Inspection Line: 503.639.4175 4 / 1 Ready Date/By: RI See Page 2 for I I(' \R I) Internet: www.tigard-or.gov 1\? N ,`t) Notified/Method: RMSupplemental Information TYPE OF WOR�` (A tt SO PLAN REVIEW ❑New construction AAddition/alteratliCm a t �N�" Please check all that apply(submit 2 sets of plans w/items checked): jj , g O Service or feeder 400 amps or more 0 Building over three stories. El Demolition 12 Other: 1u where the available fault current 0 Marinas and boatyards. CATEGORY OF COPI "RUCTIO�I-e exceeds 10.000 amps at 150 volts or 0 Floating buildings. 5' I_and 2-familydwellingCommercial/industrial less to ground,or exceeds 14.000 0 Commercial-use agricultural ❑ ❑Accessory building amps for all other installations. buildings. ❑Multi-family ❑Master builder 0 Other: ❑Fireum p p. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived _ Job site address: 100HPormore. O Addition of new motor load of system. Job#: Va7U W �`� �/t �� ❑`A E 1.2„ "l-3 City/State/ZIP: [ 1 J t� 3 4 0 e q o Six or more residential units. occupancy. 0 0 Health-care facilities. Recreational vehicle parks. Suite/bldg./apt.#: Project name: "17+ �`f A ❑Hazardous locations. 0 Supply voltage for more than L � t�1 t/� ['Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: liJ eck f�-1 in S - hl O tit S t✓ FEE SCHEDULE Ct f 0.\ Description I Qty. I Each I Total rk c,e S i\<-:\ n 5 - co r n r c� t )1 S/ 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 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK . Limited energy,residential 75.00 2 (with above sq.ft.) rt,p I q C `e E 1 e e.-t l O a iA e 1 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy 0 See Page 2 ET OTENANT Services or feeders installation,alteration,and/or relocation Name: VI,C� Ti n s ( 200 amps or less i 100.70 2 0 a-7 l7 l�t - I ae 201 amps to 400 amps 133.56 2 Address: L W (( y�l�Jp 2 401 amps to 600 amps 200.34 City/State/ZIP: "r iodic( v ( 0 q 7-1-_,;-___? 601 amps to 1,000 amps 301.04 2 Phone:(.503 )I ub -- 0 3 '7 Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: V( c_ -4 ( n 5l 4)01 On a r I .C�>�-, relocation Owner installation: his installation is b g made on property that I own which is not 200 amps or less 59.36 I intended for sale,lease,,rent,or excha a cordi to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: L-1) Date: y -�1-I/ (o 401 amps to 599 amps 168.54 2 0 APPLICANT I 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 2 branch circuit City/State/ZIP: Each add]branch circuit 7.42 2 Phone: Miscellaneous(service or feeder not included) ( ) Fax: :( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Ercall: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67.84 2 ��![[_�� Signal circuit(s)or limited-energy Address: ❑ See Page 2 2 panel,alteration,or extension. City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(I hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lie.: Electrical Lie.: Suprv. Lie.: specifically listed CA hr min) Suprv. Electrician signature,required: ELECTRICAL PERMIT FEES Subtotal: lap 0 Print name: Date: 0 Plan Review Required(25%of permit fee): „— State surcharge(12%of permit fee): /P•0 7 Authorized signature: ��_ _ TOTAL PERMIT FEE: /lq,. 7Y 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 pennit. I:Building Permits FTC_PermitApp_ELR_ERE.dor Rev 06 17 2015 440-4615T(I 105COM WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: REIbENT,IAL WORK ONLY: n. P E spa u Description 1 Qly• 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 H• eating, 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(I hr min) Inspections for which no fee is 90.00/hr P (, specifically�listed �hr min) COMMERCIAL WORK ONLY: LECT Rlce#t. PERMIT FEES allowe Subtotal(Enter on Page 1): 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 ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ O• ther: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1_Budding Permits EL( PerrnitApp ELR_ERF doe Rec 05 1,2015