Permit (65) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016-00467
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/06/2016
TIGARD 9 Parcel: 1 S134DC05300
Jurisdiction: Tigard
Site address: 11730 SW 113TH PL
Project: Heald Subdivision: MUTTLEY'S ADDITION Lot: 22
Project Description: Reconnect only.
Contractor: OWNER Owner: MILLER, JULIE K
11730 SW 113TH PL
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 06/06/2016 $67.84
Specifics:
1 ea 12%State Surcharge- 06/06/2016 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 susp: ded for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Not' - • enter. Those rules -re set forth in OAR
952-001-0010 through R 952-001-00 0. You may obtain a copy of the rules or direct questions to OUNC by ca ng 503.232.19; •r 1.800.332,2344
� w
Issued By: Permittee Signature: \ O
`— �CJa� W J
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 EC E I VE D l Olt°' ' '( I l "► OSI 1
City of Tigard Received / //_ ;.4r- Permit# LC��-.-00 y6,
13125 SW Hall Bivd.,Tigard,OR 97223 JUN 6 2016 Date/B : l� /F/
Plan Review
' s Phone: 503.718.2439 Fax: 503.598.1960Dale/B Related Permit#:
Inspection Line: 503.639.4175 CITY OF TIGARD Ready Date/By: kris: ® See Page 2 for
rll;:1 n Internet: www.tigard-or.gov BUILDING DIVISION Notified Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction 0 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.
0 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.
p 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: r 1I r� ( 3-I't''"' ❑Addition of new motor load of system.
V �‘., 100HP or more. ❑••A„ ••E„ ••l_2„ ••l_3„
City/State/ZIP: ❑Six or more residential units. occupancy.
j �r 0 Health-care facilities.
0 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 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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
`` �, .?_47,.
(with above sq.ft.)
`(/C1 L.._ ' 2co� xi... - Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
❑ PROPERTY OWNER 1 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: Aji&—,51Z.--Lo 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 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
Branch circuits-new,alteration,or extension,per panel
APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
Business name: above service or feeder fee,
^� > 1� wi j ( Faehorbr h ncirci c7.42 2
Contact name: C1vvv) B.Fee for branch circuits withoutAddress: So t cJ ' i1z?s/--(---,..f_,
`7 U service or feeder fee,first 56.18 2
<-I _l branch circuit
City/State/ZIP: cx- -i
Dr
Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(5- ) 51 L-1 V lLA. Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: �-C3C2 KA) c---c` - l ti 0- L L Reconnect only / 67.84 ,7}(i ' 2
�s NTRACTOR 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. 0 See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP: Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:
inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.. Suprv. Lic.: specifically listed(%hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 67..
Y
Print name: Date: 0 Plan Review Required(25%of permit fee):
1 State surcharge(12%of permit fee): , p-,
AuthorizedTOTAL PERMIT FEE: 7s;!,
�L �1 � This permit application expires if a permit is not obtained within 180
Print name: n Date: - (0 . 1 6 days after it has been accepted as complete.
W./' * Number of inspections allowed per permit.
l:\Building\Permits\ELC_PermitApp_ELR_E .doc Rev 06/I7,20I5 440-4615T(II/05/COMMEB
:
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
*
Fee for all residential systems combined: $75.00 Description I Qty. Each I Total I
�' 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:
n Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
El 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 I
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('h hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal Enteron Page 1):
(SEE OAR 918-309-0000) • Number of inspections allowed per permit.
Check Type of Work Involved:
n A• udio and Stereo Systems
El Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
El Outdoor Landscape Lighting*
n P• rotective Signaling
n O• ther:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:,Buildineermits: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
11730 SW 113TH PL, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00467
Jeff Grove
Violation Summary:
Inspector Contractor