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Permit (17) CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2016-00666 TfG.ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/30/2016 Parcel: 2S104AC03100 Jurisdiction: Tigard Site address: 12445 SW 134TH AVE Project: Neel Subdivision: MORNING HILL NO.8 Project Description: Reconnect furnace and a/c Lot: 175 Contractor: BRIANA M NEET Owner: NEET, BRIANA M& 12445 SW 134TH AVE HINESLY, PAULINE M TIGARD, OR 97223 12445 SW 134TH AVE TIGARD, OR 97223 PHONE: 503-329-2881 PHONE: 503-329-2889 FAX: FEES Quantity Description Date Amount Specifics: 2 crt Branch Circuits wo/Purchase 08/30/2016 $63.60 Service or Feeder 1 ea 12%State Surcharge- 08/30/2016 $7.63 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $71.23 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 ac • •.ice 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. ATT TION: Or>.on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0 10 through OAR:52-•• 0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued y `L� Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on propert wn which is not intended for sal ,lease orrent. OWNER'S SIGNATURE / C < /i// Date: 15/ad /� CONTRACTOR INSTALLATION ONLY J 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 Applicata ,, EiFOR OLEIC I': 1;51:0.\I.1 City of Tigard Receives �/ 13125 SW Hall Blvd.,Tigard,OR 9722 a 201c Date/B : �IIp Permit 4:Ems.076/4,--QO• Phone: 503.718.2439 Fax: 503.598.19600)G U Plan Review Date/B : Related Permit 4: M i✓d p !-Inspection Line: 503.639.4175COF l Li Ready Date/By: Juns: See Page 2 for TIGARDInternetwww.tigard-or.gov e , NotifiedMethod: Supplemental Info rmationALIODING DiVIIIOF TYPE OF WORK 1:1 New construction PLAN REVIEW ❑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. El Demolition 0 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-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 ❑Master builder El Other: JOB SITE INFORMATION AND LOCATION 0 Fire pump. ❑largerelsepa t ly 150 KVA or ❑Emergency system. separately derived Job#: I Job site address: j a q I�t I S 5 v t i`-'� Ate ❑Addition of new motor load of system. 'l 100lIP or more. ❑"A" «E'> `<I-2„ `<l_3" . 0 Six or more residential units. occupancy.City/State/ZIP: —7---l J . t Q qlaa ❑Health-care facilities. 0 Recreational vehicle parks._Suite/bld /apt.#: I Project name: N,ee"("-- 0 Hazardous locations. 0 Supply voltage for more than Cross street/directions to job Site: 0 Service or feeder 600 amps or more. 600 volts nominal. FEE SCHEDULE Description 1 Qty. I Each I Total I * Subdivision: New residential single-or multi-family dwelling unit. I Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 DESCRIPTION OF WORK Ea.addenergy, sq.ft.or portion 33.92 1 ir �] Limited energy,residential�'e v�of i%y l �t� �1 i� (with above sq.ft.) 75.00 2 Limited energy,multi-family residential(with above sq.ft.) 75.00 2 `PROPERTY OWNER ❑ TENANT Renewable Energy El See Page 2 Name: �� Services or feeders installation,alteration,and/or relocation A cx \\3(....e-1-- 200 amps or less 100.70 2 Address: a y S �'- t. 0 l �� 201 amps to 400 amps 133.56 2 City/State/ZIP: c,a r 1 © � 9a a.".. 401 amps to 600 amps 200.34 2 Phone:(J�-03) 3Q I_ a$$ 1 I Fax: Over601,00 to amps1,00amps 301.04 2 ( ) 1,000 or volts 552.26 2 Email: \C-el---t e CclVrC0.5+ •,\Ne-r—' Temporary services or feeders installation,alteration,and/or Owner installation:This installation is being on property that I own which madeis not 200 amps a pon mps or less 59.36 1 intended for sale,1-.. e,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: y, ce�cc- >'-7' - Date:8/3e)//40 401 amps to 599 amps 168.54 2 • APPLICANT I 0 CONTACT PERSON Branch circuits—new,alteration,or extension,ear panel Business name: A.Fee for branch circuits with above service or feeder fee, Contact name: each branch circuit 7.42 2 B.Fee for branch circuits without Address: service or feeder fee,first branch circuit 56.18 5'.. .N2 City/State/ZIP: Each add'/branch circuit / 7.42 79,3, 2 Phone:( ) I Fax::( ) Miscellaneous(service or feeder not included) Each manufactured or modular Email: dwelling,service and/or feeder 67.84 2 CONTRACTOR Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 Business name: /7 l� /J� C/ �CSign or outline lighting 67.84 2 Address: Signal circuit(s)or limited-energy panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above Phone:( ) Additional inspection(1 hr min) 66.25/hr Fax:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lic.: I Electrical Lie.: I Suprv.Lic.: specifically listed(A hr min) 90.00/hr Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES Print name: Subtotal: 6,,?. , 4,ti I Date: 0 Plan Review Required(25%of permit fee): . State surcharge(12%of permit fee): -7.4, Authorized signature , � /-i( TOTAL PERMIT FEE: � Print name: 23 This permit application expires if a permit is not obtained wih u 180 I Beravle4 JLt • NeeT I Date:�-f 3j J/� I days after it has been accepted as complete. * Number of inspections allowed per permit. I:�Building\Pertnits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 / / J 440-4615TO 1/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL.�+��7y�� FEE SCHEDULE -.... RESIDENTIAL WORK ONLY: Dexriptlon I Qty.D I Each I Total Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 2 5 kva or less 100.70 Check Type of Work Involved: 5.01 to 15 kva 133.56 2 ❑ 15.01 to 25 kva 200.34 2 Audio and Stereo Systems* 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 >100 kva-no additional charge 0.0 3 ❑ Vacuum Systems* Each additional inspection over allowable in any of the above: Each additional inspection is 66.25/hr 1 ❑ Other: charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(' hr min) ELECTRICAL PERMIT FEES COMMERCIAL WORK ONLY: Subtota1nPa(Entero gel1): 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 ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Perntits\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 12445 SW 134TH AVE, TIGARD, OR, 97223 Residential - Electrical 199 Electrical ﬁnal PASS - No C of O ELC2016-00666 Chip Barnett Violation Summary: Inspector Contractor