Permit (11) CITY OF TIGARD ELECTRICAL PERMIT
I COMMUNITY DEVELOPMENT Permit#: ELC2016-00543
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/06/2016
Parcel: 25111 DC10600
Jurisdiction: Tigard
Site address: 15680 SW ALDERBROOK CIR
Project: ROBINSON Subdivision: SUMMERFIELD NO.11 Lot: 602
Project Description: Replacing panel and(16)branch circuits.
Contractor: OWNER Owner: ROBINSON SURVIVOR'S TRUST
RALPH ROBINSON 15680 SW ALDERBROOK CR
15680 SW ALDERBROOK CIR TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 503-574-3132 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 07/06/2016 $100.70
Specifics: amps or less
16 crt Branch Circuits w/Purchase 07/06/2016 $118.72
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 07/06/2016 $26.33
Electrical
Type of Const:
Occupancy Grp:
Total $245.75
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 - •• -• by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may.• . of the ru-•• direct••estions to OUNC by calling . 2.1987 or 1.800 332.2344.
•
Issued By: >G �,. �" Permittee Signature:
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 �, *' FOR OFFICE I.SE ONI.v
Received
City of Tigard ;
Date/B . 7
13125 SW Hall Blvd.,Tigard,OR 97123
Plan Review
°, i Phone: 503.718.2439 Fax: 503.598.1960 ± n> Date/B : Related Permit#:
Inspection Line: 503.639.4175 1,;) Ready Date/By: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method:
Supplemental Information
r
TYPE OF WOR,K*' 1 � INASW PLAN REVIEW
0 New construction Addition/alterationit'eyplaceiidllit 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.
1-and 2-familydwellingCommercial/industrialless to ground,or exceeds 14,000 0 Commercial-use agricultural
�- 00 Accessory buildingg
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 15680 SW Alderbrook Circle 100HP or more. ❑"A","E","1-z",`°1-3",
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Panel Replacement 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:Duram to Alderbrook Drive,then right on FEE SCHEDULE
Alderbrook Circle(in Summerfield) 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 I
DESCRIPTION OF WORK Limited energy,residential
with above s ft.) 75.00 2
(
Replace breaker panel(150A) q•
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
I PROPERTY OWNER Renewable Energy 0 See Page 2
❑ TENANT' Services or feeders installation,alteration,and/or relocation
Name:Ralph Robinson 200 amps or less 1 100.70 100.70 2
Address: 15680 SW Alderbrook Circle 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,OR 97224 601 amps to 1,000 amps 301.04 2
Phone:(503)574-3132 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,leas rent,ore change,according to ORS 447,449,670,a d 701. 201 amps to 400 amps 125.08 2
Owner signature: / ,t Date: 7 401 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, 16
7.42 118.72 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 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder
Email: 67.84 2
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. 0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 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 Lic.: Electrical Lic.: Suprv.Lic.: specifically listed('/2 hr min)
ELECTRICAL PERMIT FEESuprv.Electrician signature,required: Subtotals` gtet y
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): .
Authorized signature: ..x. .„,„ ._G`, A
TOTAL PERMIT FEE: „).11
���•
'r This permit application expires if a permit is not obtained within 180
gALPrint name: �iT R06,1'fsb� Date: 7/6//b days after it has been accepted as complete.
`vUl�`t * Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELRERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
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
15680 SW ALDERBROOK CIR, TIGARD, OR,
97224
Residential - Electrical
115 Electrical service
PASS
ELC2016-00543
Jeff Grove
Violation Summary:
Inspector Contractor