Permit (254) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016-00884
13125 SW Hall Blvd.,Ti and OR 97223 503.718.2439 Date Issued: 11/15/2016
1 9 Parcel: 1 S 134AC00600
Jurisdiction: Tigard
Site address: 11396 SW IRONWOOD LP
Project: MacDonald Subdivision: ENGLEWOOD Lot: 34
Project Description: Master bedroom/bathroom addition. Trade work under separate permit.
Contractor: SAM HARDING INC Owner: MACDONALD, JONI C
19988 SW GASSNER RD 11396 SW IRONWOOD LOOP
BEAVERTON, OR 97007 TIGARD, OR 97223
PHONE: 503-780-6224 PHONE: 503-260-6039
FAX: 503-356-9729
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 11/15/2016 $100.70
Specifics: amps or less
2 crt Branch Circuits w/Purchase 11/15/2016 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 11/15/2016 $13.86
Electrical
Type of Const:
Occupancy Grp:
Total $129.40
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 0 : 952-001-0090. You may obtain a copy of th- les or direct questions to OUNC by calling 503.232..11987.1�33 344.
Issued By: ,
� Permittee Signature: 6�----..-1---
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 r,:, , FOR OFFICE USE ONLY
,;�
Cl ofTigard `"� - Received /
`J g : :° Date/By: ii/rsl i tp ' Permit#: L C.t2C)/l<P-Y.X')Fgli
13125 SW Hall Blvd.,Tigard,OR 9 :+r I Plan Review /
Phone: 503.718.2439 Fax: 503.598. .i t.fi���, Date/By: Related Permit#:M5720/&-00(SI
Inspection Line: 503.639.4175 \t N. ''Ready Date/By: Juris: la See Page 2 for I
Internet www.tigard-or.gov \NO ,,,?N - Notified/Method 1 I Supplemental Information
❑New construction F.4 Addition/alteration/ o' c t°.• s' Please check all that apply(submit 2 sets of plans w/items checked):
� ❑Service or feeder 400 amps or more 0 Building over three stories.
El Demolition 0 Other: x � where the available fault current 0 Marinas and boatyards.
.0,841. s_N1 i 0 ,bl 1,,co) I'a- ! ° _ exceeds 10,000 am sc at 150 volts or ❑Floatin buildin s.
,° � � � ,pi � P g g
1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑Multi-familamps for all other installations. buildings.
Multi-family 0 Master builder ❑ Other 0 Fire pump. 0 Installation of 150 KVA or
�r'a��� ' ! 71:-:
t r +® %Sd. / , •! �' ,t`'- 4,; _ ° r„ 'r ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: i 1 3ci5 i eizA\Nizct L'.a j 100HP or more. ❑"A","E",`9-2","1-3",
City/State/ZIP: `n t,Ae
❑Six or more residential units. occupancy.
n tZ
0 Health-care facilities. 0 Recreational vehicle parks.
Supply voltage for more than
0 Hazardous locations. 0
Suite/bldg./apt.#: Project name:
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: rru atioti am
Descripn . Qty. I Each
Total *
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'I 500 sq.ft.or portion 33.92 1
a'a-K.a' , _ it „, . K0*-toy :, rr iti ., , vim, Limited energy,residential
(with above sq.ft.) 75.00 2
1'1 T 133,2/9 %\4 Aqq--c t(4'4 Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
_ 'y! B r ! _ ; ;` } , ) Ex ,, Renewable Energy 0 See Page 2
� d ' " �4 x Services or feeders installation,alteration,and/or relocation
Name: j w`) a t�1 L t s.AL-1, 200 amps or less / 100.70 /00,-1 0 2
Address: t i 39(f., S.s,/J N iL. ,NGQ'� "Loc.'s?
201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: r tt c,,A , i 0e. 9 7 2.1_3 601 amps to 1,000 amps 301.04 2
Phone:(.53 ) Z40,,_ 'y`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 being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
, , ��, � � Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: i above service or feeder fee, 7.42 each branch circuit /II. I'l 2
Contact name: J 00,4 hjsG1tE.e_ B.Fee for branch circuits without
Address: i 1I(] service or feeder fee,first 56.18 2
5\isi 4. 13i AY t= branch circuit
City/State/ZIP: `j I�r*itn , v e_ C'�1 Z24 Each add'l branch circuit 7.42 2
_ Miscellaneous(service or feeder not included)
Phone:(5e3)413 -613i Fax: :(S )�c3�t-S Y-''S Each manufactured or modular
67.84 2
Email: ..�a aye, I ta-re.�-te,eiz�v tSio, 5 �,'- M Reconnect
dwelling,serviceonyand/or feeder
y „" �,° � � NY F ' only 67.84 2
_.. ... ,_ 0 0f7'_ 3 .r i> , s Purnp or irrigation circle 67.84 2
Business name: Sc;,i �etibl�/_ f U� Sign or outline lighting 67.84 2
Address: t[�y y('�,Q� ��-5,4/ �� ;�� Signal circuit(s)or limited-energy ❑ See Page 2 2
1 C [J 644iV it,lE"� l I panel,alteration,or extension.
City/State/ZIP: n (�,7 ,�y--f Each additional inspection over allowable in any of the above
4 () 1 61(2... L �& f Additional inspection(1 hr min) 66.25/hr
Phone:( / ) 7i ;. Fax:( ) Investigation(1 hr min) 90.00/hr
�- Industrial plant(1 hr min) 78.18/hr
Email:vnl-1, iia 1 -3C...0 Cten/1iU,
* Inspections for which no fee is
CCB Lic. ,> Electrical Lie.:' .<i Suprv.Lie.:672..3 specifically listed(V2 hremm) 90 00/hr
Suprv.Electrician signature,required �< tECTRT �P Mr § j s' a -"'
/' ��/'- Subtotal: /]5—,5`(
Print namer7 / 4:7R f,,, Date: iP/ ._ 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): /3.
f1 /�
Authorized signature•- �/ TOTAL PERMIT FEE: ��q 410,+ This permit application expires if a permit is not obtained within 180
Print namerref ?r 152404 t).� Date:/1-- £9 .2.646 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
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11396 SW IRONWOOD LOOP, TIGARD, OR, April 27, 2017 at 9:12:31 AM
97223
Record Type: Record ID:
Residential - Electrical ELC2016-00884
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
11396 SW IRONWOOD LP, TIGARD, OR, 97223
Record Type:
Residential - Electrical
Inspection Type:
115 Electrical service
Result:
PASS
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
November 22, 2016 at 1:07:24
PM
Record ID:
ELC2016-00884
Inspector:
Herb Stabenow
Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
11396 SW IRONWOOD LP, TIGARD, OR, 97223
Record Type:
Residential - Electrical
Inspection Type:
120 Electrical rough -in
Result:
PASS
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
Record ID:
ELC2016-00884
Inspector:
Herb Stabenow
Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
11396 SW IRONWOOD LP, TIGARD, OR, 97223
Record Type:
Residential - Electrical
Inspection Type:
115 Electrical service
Result:
PASS
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
November 22, 2016 at
10:36:15 AM
Record ID:
ELC2016-00884
Inspector:
Herb Stabenow
Contractor