Permit CITY OF TIGARD ELECTRICAL PERMIT
a R.. '' COMMUNITY DEVELOPMENT Permit#: ELC2016-00840
13125 SW Hall Blvd.,Ti Date Issued: 10/31/2016
T[Ca .R L and OR 97223 503.718.2439 9
Parcel: 2S 1048803000
Jurisdiction: Tigard
Site address: 14121 SW NORTHVIEW DR
Project: MUELLER Subdivision: CASTLE HILL Lot: 37
Project Description: (1)branch circuit for electric vehicle charger.
Contractor: OWNER Owner: MUELLER REVOCABLE TRUST
ULRICH MUELLER BY MUELLER, ULRICH M&KAREN TRS
14121 SW NORTHVIEW DR 14121 SW NORTHVIEW DR
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503-789-6730 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 10/31/2016 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/31/2016 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 OAR 952-001-0090. You may obtain a cop e rui direct questions to OUNC by calling 503/-77;:f
232 19 or 1.800.333 .2344.
Issued By: ��._ Psrr�+Et.4 Signature: ,
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 Application FOR OFFICE USE ONLY
City of TigardIN
Received /
,,,,,,AN DateB : t 0 3t / 0 Permit#: �: - / t`,4 4
13125 SW Hall Blvd.,Tigard,OR 97223 -,t,
Plan Review
Phone: 503.718.2439 Fax: 503.598. �y ti Date/B : Related Permit#:
Inspection Line: 503.639.4175 qc Ready Date/By: H See Page 2 for
Internet: www.tigard-or.gov 11, 1\W.) Notified/Method: FM. Supplemental Information
❑New construction ®Addition/alteration/rep),�i f' c�sl. ;‘'. Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition 0 Other: 1 ,' a\, " ❑Service or feeder 400 amps or more ❑Building over three stories.
® I-and 2-family dwelling where the ,000able alt current ❑Floatig bui boatyards.
i 9 ytK+I s
� ,��� exceeds 10,000 amps at 150 volts or ❑Floating buildings.
y lling ❑Commercial/indus al ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑Multi-family 0 Master builderamps for all other installations. buildings.
0 Other ❑Fire pump. 0 Installation of 150 KVA or
0 t I t° 4 ief9 irf i w ❑Emergency system. larger separately derived
Job#: Job site address: 14121 SW Northview Dr. ❑Addition of new motor load of system.
100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:Tigard/OR/97223 ❑Six or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name:EV Charger Install ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:Walnut Avenue 'AVaijCii
Description Qty. Each Total
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 I
4 'f . Limited ener
gy,residential 75.00 2
Install plug for a an Electric Vehicle charger (with above sq.ft.)
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
�� Services or feeders installation,alteration,and/or relocation
Name:Ulrich Mueller 200 amps or less 100.70 2
Address: 14121 SW Northview Dr. 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,OR,97223 601 amps to 1,000 amps 301.04 2
Phone:(503)789-6730 I 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 bein: -de on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease e t , . xc ge, .i rding to ORS 447,449,670, . d 70 . 201 amps to 400 amps 125.08 2
.../
Owner signature: A, Date: a 401 amps to 599 amps 168.54 2
6 . Branch circuits new,alteration,or extenson,per panel
A.Fee for branch circuit;with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first
branch circuit / 56.18 3 ( 2
City/State/ZIP: Each add'l branch circuit 7.42 DD 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwellin 67.84 2
Email: g,service and/or feeder
y> . za .l'7:* , e Reconnect only 67.84 2
r= Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Address: Signal circuits)orlimited-energy
panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(I 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
CCB Lic.: Electrical Lic.: Suprv.Lic.: s.ecifically listed(%z hr min) 90.00/hr
` B ffiZAl 41V4
Suprv.Electrician signature,required:
Subtotal: 5t j r
Print name: I Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): (c, 7y
Authorized signature: TOTAL PERMIT FEE. ; 6 er,A
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:\BuildingV'ermits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
14121 SW NORTHVIEW DR, 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:
ELC2016-00840
Inspector:
Chip Barnett
Contractor