Permit (28) irhCITY OF TIGARD ELECTRICAL PERMIT
�,
COMMUNITY DEVELOPMENT Permit#: ELC2016-00830
Date Issued: 10/27/2016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S27/201 2200
Jurisdiction: Tigard
Site address: 15120 SW 89TH PL
Project: Wong Subdivision: SCHECKLA PARK ESTATES Lot: 37
Project Description: Reconnect only.
Contractor: OWNER Owner: DEUTSCHE BANK NATIONAL TRUST CO
BY OCWEN LOAN SERVICING LLC
1661 WORTHINGTON
WEST PALM BEACH, FL 33409
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 10/27/2016 $67.84
Specifics:
1 ea 12%State Surcharge- 10/27/2016 $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 OA1952-10 -$090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /'
Issued By: / � Permittee Signature: t /e1 f O ✓
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.
.RECEIVE
P
Electrical Permit Application FOR Of I R 1. I SE ONLY
City of Tigard OCT 2 4 2016 Received ,o - /
DaterBv:/0 0.40 ‘&41,,mill Permit i6Z-CC:20/t)—e, yi:30
IN II 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie IMMIIIMINIMIN
1 . Phone: 503.718.2439 Fax: 503M111p11"if, '
' r 1 " ii-i Dately:
Inspection Line: 503.639.4175
Ready Date/By 1111111. FS See Page 2 for
riGARD Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method,
Supplemental Information
tVE,OF WORK ir'' ' / :::::%,,iii.„.,1' 1.4b,"..-:- `• "Of/-.RE
0 New construction El Addition/alteration/replacement Please check all that apply(submit 2 sets of plans witems checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition I Other: where the available fault current 0 Marinas and boatyards.
.:,,i::, ",:.7t::0:::0' ,!..:, veriorli ,-...%;.,; , , exceeds 10.000 amps at 150 volts or 0 Floating buildings.
f:. I-and 2-family dwelling 0 Commercial/industrial El Accessory building less to pound,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings
0 Multi-family 0 Master builder 0 Other: 0 Fire pump, 0 Installation of 150 KVA or
*Sill.t4040***-n-, 01.,4WD: OAtION nalArli.?? .!,!;, ; : 0 Emergency system. larger separately derived
C3 Addition of new motor load of system
Job#: Job site address:15120 SW 891h PI 1001IP or more.
0 Six or more residential units. occupancy.
City/State/ZIP:Tigard
D Health-care facilities, 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations_ 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: '-7r,viIII5V0*'-','.;',,-,.,
Description I OD. Earls I Total j •
SW Reiling and SW 89th
, 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
...; .6,-,, ;i.e...$ .,4W:wow i .. ,..., i i... Limited energy,residential
75.00 2
Inspect for electrical service (with above sq.ft,)
Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
Renewable Emery/ 0 See Page 2
i',.„?.;.1 ..4...."`...A.,- J&.;,.;.,",;; - , ' .4;-.''''"'''''-- ' '' Services or feeders installation,alteration,and/or relocation
Name:lisa Wong 200 amps or less 100,70 2
Address:98-05 634 road,apt 15 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Rego Park,NY 11374 601 amps to 1,000 amps 301,04 2
Phone:(971)446 3523 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 5936 I
intended for sale>,Ierzt,or exchange,according to ORS 447,449,670.and 701 201 amps to 400 amps 125.08 2
.
'
Owner signature:. Date: / Z At‘ 401 amps to 599 amps 168.54 2
0 4441. fe, ‘x, 1 0 ACT ' ' Branch circuits—new,alteration,or extension,per panel
, .., ,.. .., .1 , '.. A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: 0.Fee for branch circuits without
service or feeder fee,first
Address: branch circuit 56.18 2
City/State/ZIP: Each add'I 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:mkspros211/03@yaboo-com
Reconnect only 1 67.84 67.84 2
COINITIRACIOR 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 mint 66.25/hr
Phone:( ) Fax:( ) Investigation(I hr min) 90 00/hr
Email: Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is
i90 00/hr
CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed CA hr min)
ELECTRICAL PERMIT FEES '
Suprv.Electrician signature.required: Subtotal: 4 7 fry'
Print name: Date: . 0 Plan Review Required(25%of permit fee): ----
State surcharge(12%of permit fat):
Authorized signature: TOTAL PERMIT FEE: 76-.9 8
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit
I'.11inhfinn.Per'nal FIT PttimlApp ELR ERE doc Rev 06,17.V/15 440-4615TI 1 11)5 COMM
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL- .RK ONLY" .>r ._
Description I Qb. I Each ( Total I "
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 kyr
❑ 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
charged at an hourly(1 hr min)
Inspections for which no fee is 90.001 hr
ae. -, ,,,
specifically
tpec Ice ylisted14 ,
ustiluat
imirr
Subtotal Enteron Page i):
Fee for each commercialsystem: $75.00
" Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
O Clock Systems
❑ Data Telecommunication Installation
❑ F• ire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
O Landscape Irrigaation Control*
❑ Medical
C Nurse Calls
❑ Outdoor Landscape Lighting*
❑ P• rotective Signaling
❑ O• ther:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
I'\Suildint,PomitiJi..t'I rmitApp.1:L.R 1-R1:(104;Rer OF 171015