Permit (36) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016-00841
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/31/2016
[' �� g Parcel: 1 S134CB12500
Jurisdiction: Tigard
Site address: 12234 SW MILLVIEW CT
Project: Parsiani Subdivision: MILL VIEW Lot: 25
Project Description: (1)branch circuit for NC replacement.
Contractor: OWEN WEST ELECTRIC Owner: PARSIANI, MAHNAZ TRUST
8310 NW REED DR BY MAHNAZ PARSIANI TR
PORTLAND, OR 97229 16145 SW PEBBLE CT
BEAVERTON, OR 97007
PHONE: 503-297-6375 PHONE:
FAX: 503-297-6375
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 952-001-0090. You
may
obtain a e rules or direct questions to OUNC by calling 503. 2.1 87 oor7}►800. 32.2344.
Issued By: 44 Permittee Signature: 9 '�
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_ s �� FOR OFFICE USE ONLY
City of Tigard i �1r Date/By:.d fi/ / Permit No.: C- I , eveiv
13125 SW Hall Blvd.,Tigard,OR 97223 1. [\, Plan Review /
Phone: 503.639.4171 Fax: 503.598.1960 W-' *� 4." ateBy: Other Permit:f?7, i3)6—c '7ttS`
'IMAM)
Inspection Line: 503.639.4175 i„ ;,k, �' ,Ready/By: Jule: ® See Page 2 for
Internet: www.tigard-or.gov �,., . 4.,i % Iliiitied/Method: .7 Supplemental Information
TYPE`OF WORD '� - PLAN REVIEW
❑New construction 12 AddltiOri/alteratlO4V cement Please check all that apply(submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition El Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
a 1-and 2-family dwelling El Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
0 Emergency system. larger separately derived system.
0 Addition of new motor load of ❑"A","E","1-2","1-3",
ij
Job no.: Job site address: a} 1 ' ( 100HP or more. occupancy.
/22�� ' IDSix or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: ❑Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 145.15 4
Ea.add]500 sq.ft.or portion 33.40 1
Tax map/parcel no.: Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
/ Limited energy,multi-family 75.00 2
�P ,t A--/a. c,A. residential(with above sq.ft.)
Services or feeders installation,alteration,and/or relocation
200 amps or less 80.30 2
0 PROPERTY OWNER 0 TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
relocation
Phone:( ) Fax:( ) 200 amps or less 66.85 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 133.75 2
Branch circuits—new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
0 APPLICANT 0 CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B.Fee for branch circuits
without service or feeder fee,
Contact name:
first branch circuit "" $Zi.12
Address: Each add'l branch circuit 6.65 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular 90.90 2
dwelling,service and/or feeder
Phone:( ) Fax: :( ) Reconnect only 66.85 2 I
E-mail: Pump or irrigation circle 53.40 2 I
CONTRACTOR Sign or outline lighting 53.40 2
Business name: [N panel,
Signal circuit(s)or limited-
energy panelalteration,or
Address: 3 3 ! 0 /3 L ( extension.Describe: Page 2 2
City/State/ZIP: `` 7 `
�'' k l(._)v....
� q7 2..2_7
Z7 Each additional inspection over allowable in any of the above
Per inspection 62.50
`
Phone: &2) 8 53 0 9 5 [z Fax:( ) ,, _ Investigation per hour(1 hr min) 62.50
CCB Lic.:2 r.f Ci 2 Electrical Lic.:4 3 CO C Suprv.Lic.: Z .5'5 Industrial plant per hour 73.75
ELECTRICAL PERMIT'FEES
Suprv.Electrician signature,required: p c L c & 1...._ 1),,..., � Subtotal: -+ S'Z,it
Plan review 250 of permit fee):
Print name: �' rti 0 Ct Date: /® 3 1 & i,
u D� ! State surcharg of permit fee): —"5"--T.-4----- �"` /
Authorized signature: TOTAL PERMIT FEE: .Cfyt
?, 3 J This permit application expires if a permit is not obtained within 0
IV
Print name: Date: -• I l,e, days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC-PermitApp.doc 05/23/06 440-4615T(11/05/COM/WEB
1
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ A• udio and Stereo Systems*
❑ B• urglar Alarm
❑ Garage Door Opener*
❑ Heating,Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY
Fee for each commercial $75.00
system
(SEE OAR 918-260-260)
Check Type of Work Involved:
❑ Audio and Stereo Systems l 2-
❑ Boiler Controls
4► 8 s
❑ Clock Systems So Z a f
A
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC 32- 11 g D
❑ 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.doe 03/23/06
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
12234 SW MILLVIEW CT, 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:
November 16, 2016 at
12:10:37 PM
Record ID:
ELC2016-00841
Inspector:
Chip Barnett
Contractor