Permit (14) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016 00831
Date Issued: 10/26/2016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102DD04500
Jurisdiction: Tigard
Site address: 8575 SW JOHN CT
Project: Reconnect Subdivision: BRIDGEPARK Lot: 5
Project Description: Reconnect only.
Contractor: OWNER Owner: FEDERAL NATIONAL MORTGAGE ASSN
BY DITECH FINANCIAL LLC
7360 S KYRENE RD
TEMPE,AZ 85283
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 10/26/2016 $67.84
Specifics:
1 ea 12%State Surcharge- 10/26/2016 $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 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 952- 1-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.198,77Lor 1.800.332.2344.
Issued By: / C � Permittee Signature: G3/{/ /j�1"/)G±/(*770
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 Applicatio _ FOR OhFI(,_ I SI:ONL1
City of Tigard r Received �I�' �I a"
` "1F, DateB :/0 ' !�' Permit# e:,2e/ _ }0f3 i
N . 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960DateB Related Permit#:
_
Inspection Line: 503.639.4175 0 C 1 2 4 Z[j 16 Ready Date/By: Juris: 13 See Page 2 for
T I G A R D Internet www.tigard-or.gov Notified/Method: Supplemental Information
tit, f ` OF f1 vltW'
❑New construction • Addition/aafej ', A^ip Nr Please check all that apply(submit a sets of plans w/items checked):
Demolition "' Other:RECONNECT ❑Service feeder 400 amps more ❑Building over three stories.
where thea available fault current 0 Marinas and boatyards.
CA ", t j O t N exceeds 10,000 amps at 150 volts or 0 Floating buildings.
1-and 2-family dwelling 0 Commercial/industrialless to ground,or exceeds 14,000 0Commercial-use agricultural
0 Accessory buildingg"
ngs.
Multi-family 0 Master builder 0 Other: 0
amps for all other installations. Inbustallation
pump. ❑Installation of 150 KVA or
'`JOB'sat INFORMAT1ON;A LOCATION ❑Emergency system. larger separately derived
g ', O +' _ ` ❑Addition of new motor load of system.
Job#: Job site address: �1�Nun1 /`els loop or more. ❑"A","E","t-z",°'1-3",
City/State/ZIP: i^ `� R 0'1 as ❑Six or more residential units. occupancy.
► C V v�
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ['Hazardous locations. 0 Supply voltage for more than
N ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: Trilvm CA- .r CyQ3 Z puC
FEE SCHEDULE
JDescription I Qty• I Each 1 Total
New residential single-or multi-family dwelling unit.
Subdivision: .62,_ #: 5 Includes attached garage.
Tax map/parcel#: a lvl�C2355 1,000 sq.ft.or less 168.54 4
Q Ea.add'l 500 sq.ft.or portion 33.92 1
`Dtse , ON" ''WORK Limited energy,residential 75.00 2
POWER HAS BEEN OFF MORE THAN 6 MONTHS (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
t3 OFERTY OWNS Services or feeders installation,alteration,and/or relocation
Name: 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 t
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
' : A1*PI.I+^A2wiN C®1V I C 'p ON' A.Fee for branch circuits with
Business name:ROSE COUNTRY REALRY above service or feeder fee, 7.42 2
each branch circuit
Contact name:ANNIE WRUCKE B.Fee for branch circuits without
service or feeder fee,first
Address:2050 BEAVERCREEK RD#101 branch circuit 56.18 2
City/State/ZIP:OREGON CITY OR 97045 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(971)570-2216 Fax: :(503)200-1298 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:ASSISTANT@OREGONREO.COM Reconnect only 1 67.84 67.84 2
CONTRACTOR " Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited energy 0 See Page 22 2
panel,alteration,or extension.
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(%3 hr min)
EltriticAL PERMIT FEES, ;
Suprv.Electrician signature,required:
Subtotal: 67.84
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 8.14
Authorized Sigrna�ems: p� -y e TOTAL PERMIT FEE: 75.98
anU 1 1 �A �T� / This permit application expires if a permit is not obtained within 180
Print name: Date: V r!_ days after it has been accepted as complete.
�P * Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB