Permit CITY OF TIGARD
'' COMMUNITY DEVELOPMENT ELECTRICAL PERMIT
'� Permit#: ELC2016-00733
Date Issued: 09/26/2016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135DB06000
Jurisdiction: Tigard
Site address: 11540 SW GREENBURG RD
Project: Galeana Subdivision: MILLER Lot: 6
Project Description: Electrical service for accessory structure,(1)feeder and(8)branch circuits.
Contractor: OWNER Owner: GALEANA, EUNICE
11540 SW GREENBURG RD
TIGARD, OR 97223
PHONE:
PHONE
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 09/26/2016 $100.70
Specifics: amps or less
8 crt Branch Circuits w/Purchase 09/26/2016 $59.36
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 09/26/2016 $19.21
Electrical
Type of Const:
Occupancy Grp:
Total $179.27
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 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. TENTION: Ore" law r•uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 1-0010 through OAR 9 .01-0090. •u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.33 144Is ued By: , I "/ O4L.d1.( / Permittee Signature: \C.
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not inten arsafe,lease or rent.
OWNER'S SIGNATURE x- (6°. _
Date: ?/0‘,, ,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 ApplicatittECEIVEP FOR OFFICE 1 SE Oy,.v
City of Tigard Received q/ /& L6�/(y/ 7 33
It Date/B T� w i Permit#:
• 13125 SW Hall Blvd.,Tigard,OR 972PE P 2 6 2.016 Plan Review
Ill Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
7,'GAIZ Inspection Line: 503.639.4175 CITY
ry I '^ / k �" I s( Rj y Ready Date/By: Jug: la See Page 2 for
Internet: www.tigard-or.gov �{{'iiiil��11��AA5r�j DIVISION
rJ Notified/Method: Supplemental Information
TYPE iilWIMING DIVISION PLAN REVIEW
❑New construction ❑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 ID 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 ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: I Job site address: 11 q &,c) (pQl � Qe ❑Addition of new motor load of system.
100HP or more. ❑«A" "E" "1-2" "1-3"
City/State/ZIP: 2 0 Six or more residential units. occupancy.
7 0 Health-care facilities. ❑Recreational vehicle parks.
g 0 Hazardous locations. 0 Supply voltage for more than
Suite/bldg./apt.#: Project name: (v iA`�.t .5 Si--v 4 l '(J ['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: I 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 O WORK Limited energy,residential
�'/���r, ) 02 02: 1,..-41--40-1-
2 y 7�
(with above sq. lti 75.00 2
U �.1�1 Li/ C.� !(� Limited energy,multi-family
0
residential(with above sq.ft.) 75.00 2
0 PROPERTY OWNER Renewable Energy 0 See Page 2
0 TENANT Services or feeders installation,alt ration,and/or relocation
Name: :-•; 01(\ ICC `F)G 1 e c& to 200 amps or less 1 100.70 /119.7c 2
` `t J 201 amps to 400 amps 133.56 2
Address:
(k Lr 0 S O f t r'O `bJY �LL 401 amps to 600 amps 200.34 2
City/State/ZIP: l ‘ Aid n V- bf 7 22_ 3 601 amps to 1,000 amps 30104 2
Phone:(503 c('5 7 O L/ 2,I Fax:( ) Over 1,000 amps or volts 552.26 2
( Temporary services or feeders installation,alteration,and/or
Email: t)n t CC . ct f eon fl q yp.0 (3 Mzt I) ' C O rr-) relocation
Owner installation:This instal ation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rento,;,,-xchan•�.�,.���'` :to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 _ 2
Owner signature: ..,1111F"-- 7s���.� Date: Cfr-24—/( 401 amps to 599 amps 168.54 2
APPL ANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 0
7.42 57.1 2
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 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
X)Address: /
0l 1� ) e a- Signal circuit(s)or limited-energy 0 See Pa e 2 2
panel,alteration,or extension. g
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
Industrial plant(1 hr min) 78A 8/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: /(j7aC"&
Print name: Date: 0 Plan Review Required(25%of permit fee): - lI%
State surcharge(12%of permit fee): /L'
Authorized signature: , T TOTAL PERMIT FEE: q, of
e .
This permit application expires if a permit is not obt`fern wttnm so`, ,e
1""
Print name: d yk r Ge f�/ l .4 ri c., Date: 9,_20 — /6` days after it has been accepted as complete
v` * Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB r
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 Total
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 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%z hr min)
COMMERCIAL WOR ONLY; LECTRICAL, PERMIT FEES
SubtotalEnteron Page 1):
Fee for each commercial system: $75.00
y * 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\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11540 SW GREENBURG RD, TIGARD, February 1 , 2018 at
OR, 97223 12:02:47 PM
Record Type: Record ID:
Residential - Electrical ELC2016-00733
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Corrections complete.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11540 SW GREENBURG RD, TIGARD, December 27, 2017 at
OR, 97223 11 :24:00 AM
Record Type: Record ID:
Residential - Electrical ELC2016-00733
Inspection Type: Inspector:
199 Electrical final David Young
Result:
FA I L
Comments:
Exterior gfci outlets except under porch not tripping.
Protect exposed Romex to water heater.
Interior outlets not arc fault or gfci protected.
Violation Summary:
Inspector Contractor