Permit (257) CITY OF TIGARD ELECTRICAL PERMIT
I ■ COMMUNITY DEVELOPMENT Permit#: ELC2016-00916
T I(-A h.[} 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/05/2016
Parcel: 2S 111 CC 15400
Jurisdiction: Tigard
Site address: 10055 SW HIGHLAND DR
Project: Clouser Subdivision: SUMMERFIELD NO.4 Lot: 205
Project Description: (8)branch circuits for kitchen remodel
Contractor: R&D ELECTRIC INC Owner: CLOUSER, PENELOPE L
PO BOX 868 10055 SW HIGHLAND DR
MULINO, OR 97042 TIGARD, OR 97224
PHONE: 503-679-7987 PHONE:
FAX:
FEES
Quantity Description Date Amount
Specifics: 8 crt Branch Circuits wo/Purchase 12/05/2016 $108.12
Service or Feeder
1 ea 12%State Surcharge- 12/05/2016 $12.97
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $121.09
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. ATT �re on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-00' 010 through OAR 52-001- 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 2.1987 or 1.800.332.2344.
Issu By: )1�ip �y(- -, —/ Permittee Sinature: \ ^ -�
9 / " '/ ti - C/-t--t.:—e_
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' dlilliab 4� ��� Date: 4/////�
LICENSE NO. 5 345-4/5
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 Applicati I I ., v EOR OFFICE I SE ONE
City of Tigard Received !, � , �Q l/
. a 3
13125 SW Hall Blvd.,Tigard,OR 972 Date/B : g 0-7* ( t Permit#: ` �QQ�
(, n Plan Review
Phone: 503.718.2439 Fax: 503.598.1194i
0.. !(i I F) DateB Related Permit 4:
Inspection Line: 503.639.4175 y: WI See Page 2 for
T I GA R D Ready DateB Iuris:
Internet: www.tigard-or.gov ,,...f„,s ' 1.1 , Notified/Method: Supplemental Information
❑New construction Addition/alteration/r acement 55 ' Pleasecheck all that apply )
epl (submit 2 sets of plans w/items checked):
❑Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current 0 Marinas and boatyards.
21: CA C �'.`" exceeds 10,000 amps at 150 volts or ❑Floating buildings.
and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑Multi-family amps for all other installations. buildings.
Y 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
a. ,t fes; A"CIEIIhI ❑Emergency system. larger separately derived
Job#: Job site address: I CO GG u ❑Addition of new motor load of system.
� H1 k,,..0 ,z. loOHP or more. ❑"A" "E""1-2""1-3»
City/State/ZIP: t G cir-•r.1 1 C)9, C 1 a J ❑Health-care
It mare facilites. units. Recreational
c anon.
J "t ❑Health-care facilities. ❑Rvehicle parks.
Suite/bldg./apt.#: I 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:
Description I Qty. r Each 1 Total 1*-
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
E` lo W0 r Em.atdedd 1e5n0rgyq,.reftiodrentirtalin 33.92 1
� (with above sq.ft.) 75.00 2
''h\i-C he t'\ e Prey..ke A Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Cl aPltf plER' OIr Renewable Energy ❑ See Page 2
' �` "irt$ Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
City/State/ZIP:
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) 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
. ,[3,,,,4,-,
' -,,:r j am Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
Contact name:
each branch circuit 7.42 2
B.Fee for branch circuits without
Address: service or feeder fee,first I 56.18 s 6 1-x'2
branch circuit U
City/State/ZIP: Each add'l branch circuit '7 7.42 2
Phone:( ) I Miscellaneous(service or feeder not included)
Fax: :( ) Each manufactured or modular
67.84 2
Email: dwelling,service and/or feeder
Reconnect only 67.84 2
.ti-, '' ' 4CTO Pump or irrigation circle 67.84 2
Business name: 1 470 E 1 e.c*r l C . -i,- Sign or outline lighting 67.84 2
Address:
'---?,Cy--,6 �j 1 ,�j Signal circuit(s)or limited-energy
®xC e'S CQ Q panel,alteration,or extension. 0 Page 2 2
Each additional ins ection over allowable in any of the above
City/State/ZIP: MU,`not 0� C1,0LA
Additional inspection(1 hr min) 66.25/hr
Phone:(C 03) &Is "-)C\ g(37 I Fax:( ) Investigation(1 lir ) 90.00/hr
Email: R ltom,1 ca l c4.).e...-t- Industrial plant(1 hr min) 78.18/hr
1-1 3‘.. (--1Inspections for which no fee is
CCB Lic.: I Electrical Lie.:a I Suprv.Lic.: 5 s.• ificall listed %hr min III
90.00/hr
Suprv.Electrician signature, 4,f „,� :;p gnature,required:\----
'A Z-- - Subtotaie,g
Print nam• . N.- Date:” V/ 0 Plan Review Required(25%of permit fee):_ �^
t, State surcharge(12%of permit fee): / ,97
Authorized signatu 1 , ••\ \ �j. � TOTAL PERMIT FEE: /Ai,o9
Print name: ` C `- This permit application expires if a permit is not obtained within 180
i 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(t l/OS/COM/WEB