Permit (19) CITY OF TIGARD ELECTRICAL PERMIT
III al
COMMUNITY DEVELOPMENTPermit#: ELC2016-00414
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 It , ` Date Issued: 05/19/2016
lilParcel: 2S103BD10800
Jurisdiction: Tigard
Site address: 11710 SW WALNUT ST
Project: Furlott Subdivision: 2003-045 PARTITION PLAT Lot: 1
Project Description: Switched receptacles in back of shop. 5/24/16:REPRINTED permit to include(1)200 amp service and(4)branch
circuits.
Contractor: PDX ELECTRIC LLC Owner: FURLOTT, RYAN C
7933 WHITFURROWS CT KATO,ALYSHA C
DURHAM, OR 97224 11710 SW WALNUT ST
TIGARD, OR 97223
PHONE: 503-997-1989 PHONE:
FAX: 503-200-1362
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 05/24/2016 $100.70
Specifics:, amps or less
5 crt Branch Circuits w/Purchase 05/19/2016 $37.10
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 05/24/2016 $16.54
Electrical
Type of Const: 45 Misc Administration Fee 05/24/2016 $45.00
Occupancy Grp:
Total $199.34
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 0 952-001-0090. in a the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
e
Issued By: Permittee Signature: Aect=2P „--\..”
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 cJ' N FOR Oil i( 1: 1 "F.O.L.'
Received
City of Tigard �ate,By: 3 tie r,- emrit#: L1:.�1�-"(S(�l
1111 13125 SW Hall Blvd,Tigard,OR 97223 2 Plan Review
a Phone: 503.718.2439 Pax: 503.598.1960 '!�y Related Permit#:
Inspection Line: 503.639.4175 +� tl I te/By: Auris: fit See Page 2 for
TIG\R[) Internet: www.tigard-or.gov �,1.� V� �{� , 4 ,t:thod: ', Supplemental Information
TYPE OF WORK R9aom 1.+i PLAN REVIEW
❑New construction ®Add ition/alteration/re 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 0 Other:
where the available fault current 0Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
®1-and 2-family dwelling 0 Commercialindustrial 0 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 ❑Emergency system. larger separately derived
AddJob#: Job site address:11710 SW Walnut St ❑10011P on of new motor load of system.
OOFIP or more. ❑"A^,••E,,,«i_2.•«1.3",
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy.
❑Health-care.facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project namerT1M7MEte er fy / 0 Hazardous locations. 0 Supply voltage for more than
' r* ❑Service or feeder 600 amps or more. 600 volt*nominal
Cross street/directions to job site: FEE"SCHEDULE
Desertpnon I Qty. I Tech 1 Total 1 •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.R.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
(with above sq.ft.) 75.00 2
�
�, o(J a 1%X 1 t-h\t�R I�(r (� Limited energy,multi-family 75.00 2
J residential(with above sq.ft.)
PROPERTY,OWNER Renewable Energy CI See Page 2
0 TENANT Services or feeders instailationLalteratlon,and/or relocation
Name:
U'bj j -t0 I) 200 amps or less i 100.70 IDD.3-01 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
Email: Temporary services or feeders installation,alteration,and/or
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,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 1.- 7.42 211 L, 2
Miscellaneous(service or feeder not included)
Phone:( ) 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:PDX Electric Sign or outline lighting 67.84 2
Address:15816 SW Upper Boones FerryRd Signall,alteration,
or extension.
0 See Page 2 2
pp panel,alteration,or extension.
City/State/ZIP:Lake Oswego,OR 97035 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/lir
Phone:(503)639-9708 Fax:(503)200-1362 Investigation(1 hr min) 90.001 hr
Email:michelle@pdxelectric.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.001 hr
CCB Lic.: 192731 Electrical Lie.: C696 Suprv.Lie.: 5612S specifically listed('f,hr min)
• ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required. _iSubtotal: /3 D, �J
Print name: Marty Palmer Date: 05/23/2016 0Plast Review Required(25%of permit fee):
State surcharge(12%of permit fee): 1(5 , (g
Authorized signature: TOTAL PERMIT FEE: )ti(,, 03
This permit application expires if a permit is not obtained within 180
Print name: Michelle Morato Date: 05/23/201615 days after it has been accepted as complete.
Number of inspections allowed per permit.
1:tBuildinglPermit3tELC_PcmmhApp_ELR_ERE.doc Rev 06/172015 440-4615T(11/05/COMJWEB