Permit CITY OF TIGARD ELECTRICAL PERMIT
n COMMUNITY DEVELOPMENT Permit#: ELC2016-00470
TFGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/07/2016
Parcel: 1 S134DB05300
Jurisdiction: Tigard
Site address: 11260 SW NORTH DAKOTA ST
Project: WOLFE Subdivision: 1992-049 PARTITION PLAT Lot: 2
Project Description: Replacing meter box for recreational vehicle connection:(1)service and(1)branch circuit.
Contractor: OWNER Owner: WOLFE, DUSTIN
DIANA KRUSE 11260 SW NORTH DAKOTA
17720 SW SHADY FIR LOOP TIGARD, OR 97223
BEAVERTON, OR 97006
PHONE PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 06/07/2016 $100.70
Specifics: amps or less
1 crt Branch Circuits w/Purchase 06/07/2016 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 06/07/2016 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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. Yo •. '•a copy of .r direct questions to OUNC by calling 50 .232.1987 or 1.800.332.2344.
Issued By: - — •--rmittee Signature: al ��/ . 2 /
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.
1
Electrical Permit Application FOR OFFICE USE ONLY
City ofTigard `✓ Received
IliCC Date/B : . ��i�•Z li
ri
'f 13125 SW Hall Blvd.,Tigard,OR 972 TA
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 w` 1• Date/B : Related Permit#:
Inspection Line: 503.639.4175 J� PRS ady Date/By: �� El See Page 2 for
TIGARP, Internet: www.tigard-or.gov \�� �(,NO`�\-e`��vitified/Method: �� Supplemental Information
TYPE OF WORKO L t.V., PLAN REVIEW
0 New construction XcAddition/alteraticemipracement 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.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
XI-and 2-fami ly dwelling ❑Commercial/industrial 11Accessory building less to ground.or exceeds 14.000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑ Muld-family 0 Master builder ❑Other: ❑Fireum
p p. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
�v( � 100
❑Addition of new motor load of system.
Job#: Job site address: I - N
a
IOOHP or more. ❑"A' "E" "I-2" "1-3"
t
City/State/ZIP: � �` n o 1.7. ,,.2..:_>,-, �. ❑Six or more residential units. occupancy.
J t���"i/I t,/ ❑Health-care facilities. ❑Recreational vehicle parks.
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 Qtv. 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 OF WORK Limited energy,residential 75.00 2
i*Lt2, )/iLe Oe' — C y^ y�� � _ ) (with above,sq. t)
�/ ��J)C/�7 p�►�r 1� �j/'�Q,/� Limited energy,multi-family91e4. 0-ta 75.00 2
O '�"����-e-f"e/ � . ii44_����`'e47 V residential(with above sq.ft.)
Renewable Energy 0 See Page 2
PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: _7)//1704, ` 2j,cs- 200 amps or less j 100.70 2
71,A0 A ,_) 5_14-20 Fj R/ / 201 amps to 400 amps 133.56 2
Address: (�(/ L►OD
401 amps to 600 amps 200.34 2
City/State/ZIP: {i JgQJ R A ion �i� 601 amps to 1,000 amps 301.04 2
",�' tette ( �/ Over 1,000 amps or volts 552.26 2
Phone:(� )�g0- b---1q7 Fax:( �)
Fe1 Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made n property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,orjexchan according to ORS 447,449,670,and 01. 201 amps to 400 amps 125.08 2
Owner signature: btfiiKe .,/'y1 ' Date:J 7 ,/ , 401 amps to 599 amps 168.54 2
APPLICANTBranch circuits—new,alteration,or extension,per panel
00 CONTACT P RS N
A.Fee for branch circuits with
Business name: above service or feeder fee, I
7.42
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first
Address: branch circuit 56.18 2
City/State/ZIP:
Each add'I branch circuit 7.42 2
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
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. ❑ 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
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('_hr min)
ELECTRICAL PERMIT FEES log'Suprv. Electrician signature,required: Subtotal: lo3 •Ix'
Print name: Date: 0 Plan Review Required(25%of pennit fee): .------"
State surcharge(12%of permit fee): [a.97
TOTAL PERMIT FEE:
Authorized signature: la .�9
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.
1:Building'.Permits,ELC_PermitApp_ELR_ERE.doc Rev 06'172015 440-4615T(I L05'COM'WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. I Each I 7olal
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 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
charged at an hourly(1 hr min) _Lob
Inspections for which no fee is 90.00/hr
specifically listed('/z hr min)
COMMERCIAL WORK ONLY: ELECTRICALT FEES
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
n Boiler Controls
Clock Systems
Data Telecommunication Installation
I Fire Alarm Installation
HVAC
Instrumentation
Intercom and Paging Systems
n Landscape Irrigation Control*
Medical
I I Nurse Calls
I I Outdoor Landscape Lighting*
Protective Signaling
Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
(:\Building,Permits\ELC_PermitApp_ELR_ERE.doc Rev 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
11260 SW NORTH DAKOTA ST, TIGARD, OR,
97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00470
Jeff Grove
Please strap conduit at each end
Violation Summary:
Inspector Contractor