Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016-00871
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/09/2016
T[� ' g Parcel: 1 S134ACO2648
Jurisdiction: Tigard
Site address: 11060 SW COTTONWOOD LN
Project: MCKIBBIN Subdivision: ENGLEWOOD NO.3 Lot: 214
Project Description: Finish work for outlets,switches,lighting,range and exhaust hood.
Contractor: OWNER Owner: MCKIBBIN,TERRY
TERRY MCKIBBIN DONOHUE, ERIN
11060 SW COTTONWOOD LN 11060 SW COTTONWOOD LN
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 720-244-5930 PHONE:
FAX:
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo/Purchase 11/09/2016 $78.44
Specifics: Service or Feeder
1 ea 12%State Surcharge- 11/09/2016 $9.41
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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. Yfou mAMAXIobtain les or direct questions to OUNC by calling 503.232.1987 or 1.800.33 4
Issued By: 71 7L ,-- Permittee 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.
Cali 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 0111(1: Fsr. ON 1.1
City of TigardReceived %f Mira >�
CtliViiii) Date/B Permit#: i-- `!(L,_;y Ly'
71 q 13125 SW Hall Blvd.,Tigard ORPlan Review vw
C Phone: 503.718.2439 Fax: 503.5', ,'' I Date/B : Related Permit#: � ._
Inspection Line: 503.639.4175 Ready Date/By: Juris: ® See Page 2 for
I i G A R O Internet: www.tigard-or.gov 1Tb Notified/Method: >
��(� Supplemental Information
PE OF WOIevmolt PLAN REVIEW
0 New construction IIVAddition/alterati,0110445Please check all that apply(submit 2 sets of plans w/items checked):
0 ❑Other: „T(� • t( 1M 0 Service or feeder 400 amps or more
Demolition . P 0 Building over three stories.
G A where the available fault current 0 Marinas and boatyards.
CATEGORY OF CO N exceeds 10,000 amps at 150 volts or 0 Floating buildings.
and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fireum .
P P 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address: kk jj / �/
❑Addition of new motor load of system.
/r/!J C/Q S� C i/��f+4,),.,,al 100HP or more. ❑«A>, «E„ «1.2„ «1.3„
City/State/ZIP: ..a -..i '/� 9-7 Z z ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:7%76 /..)b,),\„) ElHazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: //S_fh /-G` 6.i /'
�/Ct1 u..";:Ci i,--.1 , FEE SCHEDULE
Description I Qty. I Each I Total
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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
L
J / (with above sq.ft.) 75.00 2
f rri c'.S)1 ti 1 G i r d f a/ /e-� a 1 h // e o Ve. c Limited energy,multi-family
4.'vt/ C � ��, A t 1 t 1 Al V Pv f residential(with above sq.ft.) 75.00 2
J� T 1/ • -•�1 �`� a�f /Gel Renewable Energy ❑ See Page 2
PROPERTY WNER/ 45 TENANT
Services or feeders installation,alteration,and/or relocation
Name:
p v,/,. G A 2 J/i4 200 amps or less 100.70 2
Address: //c7_O 5 4t,1 /' hit toe of 2_..,,, 201 amps to 400 amps 133.56 2
` l 401 amps to 600 amps 200.34 2
City/State/ZIP: ""`t_ <a i.,j z-)A 9 7z Z 3 601 amps to 1,000 amps 301.04 2
Phone:(7 )) 2__y ._s-9 3 0Fax:( ) Over 1,000 amps or volts 552.26 2
Email: / Temporary services or feeders installation,alteration,and/or
tet_ lirk �k-•i :c) c'.i'G'•7 C C{5t. al �f relocation
Owner instal tion:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchan -ording to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: _...„,.. ,,,,,' L, Date: ///7//o 401 amps to 599 amps 168.54 2
0 APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 1 56.18 �?- 1 U 2
branch circuit / u
City/State/ZIP: Each add'l branch circuit 7 7.42 r (. 2
Miscellaneous(service or feeder not included) �4Y
Phone:( ) Fax::( ) Each manufactured or modular
Email: dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
CONTRACTOR 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
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(%2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): q. L1 1
Authorized signature: TOTAL PERMIT FEE: 'F7 1
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_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. I Each I Total I *
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
n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n 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 90.00/hr
specifically listed('/hr min)
COMMERCIAL WORK ONLY: ,ELECTRICALS PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
in O• utdoor Landscape Lighting*
❑ Protective Signaling
n O• ther:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELCPermitApp_ELR_ERE.doc Rev 06/17/2015
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
11060 SW COTTONWOOD LN, 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:
ELC2016-00871
Inspector:
Chip Barnett
Contractor