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Permit (29) CITY OF TIGARD ELECTRICAL PERMIT :IPI COMMUNITY DEVELOPMENT Permit#: ELC2016-00838 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/31/2016 T t c_ ;�1;t� 9 Parcel: 2S102CD05000 Jurisdiction: Tigard Site address: 9815 SW OMARA ST Project: Cook Subdivision: 1992-012 PARTITION PLAT Lot: 3 Project Description: Replace electrical panel. Contractor: DOREEN COOK Owner: COOK, DOREEN M 9815 SW OMARA 9815 SW O'MARA ST TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503-740-2154 PHONE: 503-740-2154 FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders-200 10/31/2016 $100.70 Specifics: amps or less 1 ea 12%State Surcharge- 10/31/2016 $28.11 Type of Use: SF Electrical Class of Work: ALT 0 ea 12%State Surcharge- 10/31/2016 $-16.03 Electrical Type of Const: Occupancy Grp: Total $112.78 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. ATTE . a egon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00 through OA 952--0091/0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issue. =y: �6�1� �.A _� -/ Permittee Signature: d�,j�y 1'\ �'ILEE� OUoK OWNER INSTALLATION ONLY R The installation is being made on property I own which is not intended for sale,lease or rent. r/ / � C oh�e�c.C,bo.� / 74 Date: /8/31 / OWNER'S SIGNATURE 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 Applica '�•" y CFI s'+14', FOR OH'ICE I'SI:ONLY City of Tigard T Received �I��' _ E�COt//l!/.. g 3 Date/B Permit#: 13125 SW Hall Blvd.,Tigard,OR 97223IN Plan Review Phone: 503.718.2439 Fax: 503.5980''61i 3 12016 Date/B : Related Permit#: 1 I G A R I> Inspection Line: 503.639.4175 Ready Date/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov c i,. ., 1( - Notified/Method: ii-N���+ '"�I�t .� (� Supplemental Information TYPE + V Please check all that apply E(submitit 2Riso palns w/items checked):0V !' �❑New construction Additl r Plac mep 0 Service or feeder 400 amps or more 0 Building over three stories. 0 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. a1-and 2-family dwelling ❑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 0 Other: ❑Fireum P P 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address: G 0 Addition of new motor load of system. / r S 5 Li) O Yrs & CA 100HP or more. ❑"A" "E" "l-2" "l-3„ City/State/ZIP: <<� Six or more residential units. occupancy. y i g7 2Z 3 0 ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: 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: FEE SCHEDULE Description I Qty. i Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential Rt_p(CcCia v � Z UQ ttd _ i . (with above sq.ft.) 75.00 2 Limited energy,multi-family residential(with above sq.ft.) 75.00 2 ' Renewable Energy 0 See Page 2 ®.PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation Name: 1),,,^e r.t,t L c,ci K 200 amps or less / 100.70 /i.'j,.7O 2 Address: 9 ' 1 S s...t} 6 t,,,,,c.'i!cl 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: ?i c,,,,A. ©R. -7 2-.3 601 amps to 1,000 amps 301.04 2 Phone:(s-c 3 ) 7'/ ) 'Z i S-1-1 Fax:( ) Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or 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,or exchange,according to 0A447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature. _ g - �u ,��• Date:/!1 3/-?O/6 401 amps to 599 amps 168.54 2 4 APPLICANT 4 I ACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, 7 each branch circuit zit_ 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 Email: dwelling,service and/or feeder 67.84 2 Reconnect only 67.84 2 CONTRACTOR )G. Pump or irrigation circle 67.84 2 OBusiness 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(V2 hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: lDb 7O _ Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): /A•o$ Authorized signature: TOTAL PERMIT FEE: `/of .?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:\Building\Permits\ELC_PermitAppELRERE.doc Rev 06/17/2015 440-4615T(1 I/05/COM/WEB Electrical Permit Application—City of Tigard Page 2-Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: - M tiri Description Qty. Each Total Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 5 kva or less 100.70 2 Check Type of Work Involved: 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 with OAR 918-309-0040) 552.26 2 ❑ 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 90.00/hr specifically listed(/z hr min) v.ELEERCAPEMa EE ViltP Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 * Number of inspections allowed per pennit. (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_PermitAppELR_ERE.doc Rev 06/17/2015 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 9815 SW OMARA ST, TIGARD, OR, 97223 Record Type: Residential - Electrical Inspection Type: 199 Electrical final Result: PASS- NoCofO Comments: Violation Summary: Inspector Tel: 503.718.2439 Inspection Date: Record ID: ELC2016-00838 Inspector: Jeff Grove Contractor 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 9815 SW OMARA ST, TIGARD, OR, 97223 Record Type: Residential - Electrical Inspection Type: 115 Electrical service Result: PASS Comments: Violation Summary: Inspector Tel: 503.718.2439 Inspection Date: Record ID: ELC2016-00838 Inspector: Jeff Grove Contractor