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Permit (269) CITY OF TIGARD ELECTRICAL PERMIT 2. COMMUNITY DEVELOPMENT Permit#: ELC2016-00956 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/20/2016 T[G ARE) g Parcel: 1 S135DC03500 Jurisdiction: Tigard Site address: 11680 SW 95TH AVE Project: MONTGOMERY Subdivision: FIRDALE-UNRECORDED Lot: 7 Project Description: Altering(1)branch circuit for(4)new recessed lights. Contractor: OWNER Owner: MONTGOMERY, CORY L CORY MONTGOMERY MONTGOMERY, DEANA S MCFADDEN 11680 SW 95TH AVE 11680 SW 95TH AVE TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503-737-7159 PHONE: FAX: FEES Quantity Description Date Amount 1 crt Branch Circuits wo/Purchase 12/20/2016 $56.18 Specifics: Service or Feeder 1 ea 12%State Surcharge- 12/20/2016 $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. Yo .a obtai. .py of the rues.'r direct questions to OUNC by calling 503.23 988-i x0.3 J,.2344. Issued By: • Peittee Signature: / � /� rm 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 Folz ori ici: I. SI. 011.v p City of Tigard q r 'RReceived � t Da[e/B 1 Fr/N 1111 ;, u 13125 SW Hall Blvd.,Tigard,OR 97223 'A Plan Review J _ Phone: 503.718.2439 Fax: 503.598.196 i Date/B : Related Permit#:I t Inspection Line: 503.639.4175 �c, Ready Date/By: ® See Page 2 for Notified Method: Supplemental Info rmation Internet: www.tigard-or.gov tEC 2 � ,TYPE OF WORK 1ctu ry`y4MU) PLAN REVIEW ❑New construction Addition/alteration/. gin rt 1g Please check all that apply(submit 2 sets of plans w/items checked): 11 Demolition ` � � ,`i l 0 Service or feeder 400 amps or more 0 Building over three stories. Demolition Other: lji �1�1 where the available fault current 0 Marinas and boatyards. � CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. E 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amp❑Multi-family ❑Master builder ❑Other: Fire for all other installations. Insbutallation 0 Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived //', 3")/ / ` ❑Addition of new motor load of system. Job#: Job site address: 9 5 ttc) 75 t 4._ i/L 100HP or more. ❑ A» "E» 1.2» l_3„ ❑Six or more residential units. occupancy. City/State/ZIP: "✓0 J ,7 cl 7 Z 2 3Recreational vehicle arks. ❑Health-care facilities. 0 P Suite/bldg./apt.#: 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: 6/ - -1\J/3 u • 6 Z Cj C't1"- FEE SCHEDULE Description I Qty. I Each I Total I * 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 DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 2 /9- ,,o1/Ul �� /2CC L'.3 J CV L/6:/.7,rs r Limited energy,multi-family residential(with above sq.ft.) 75.00 2 l SCCA-'0 UCT' e f-i9.ti ,2 L Jam ✓ Renewable Energy 0 See Page 2 +J 4ROPERTY OWNER 0 TENANT ': Services or feeders installation,alteration,and/or relocation Name: .*: `J 200 amps or less 100.70 2 Address: // �+ / 201 amps to 400 amps 133.56 2 �ievr() -1''4-t-) 9 5-_/� il�G - 401 amps to 600 amps 200.34 2 City/State/ZIP: /4,9 / e2C9' 601 amps to 1,000 amps 301.04 2 Phone:(5 )3) '73 7._ 7/5-9 Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: evj, 79©,c, y J 2 jp j , -1 l'y2 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 exchan,:,a' ording to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 401 amps signature: c., - r • -� -"- Date: (Z -ZU-16 to 599 amps 168.54 2 APPLI-ANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, each branch circuit 7'42 2 Contact name: B.Fee for branch circuits without service or feeder fee,first 1 Address: branch circuit ` 56.18 C 7, ( 2 City/State/ZIP: Each add'I branch circuit 7.42 -�4 2 Phone: Miscellaneous(service or feeder not included) ( ) Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: 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('/hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: 57 l g Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): 47• 71 Authorized signature: TOTAL PERMIT FEE: (0)-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_ELRERE.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 Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ 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 3 111 Vacuum Systems* >100 kva-no additional charge 0.0 3 Each additional inspection over allowable in any of the above: [II Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(A hr min) COMMERCIAL WORK ONLY: ELEC RICAL PERMIT FEES Fee for each commercial system: $75.00 allowed Subtotal permit.ter Page 1): y ' Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation n Fire Alarm Installation ❑ HVAC ❑ Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* n Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 13125 SW Hall Blvd. Tigard, OR 97223 Location: 11680 SW 95TH AVE, Record Type: Residential - Electrical Inspection Type: 199 Electrical final Result: PASS- NoCofO Comments: Violation Summary: Inspector City of Tigard TIGARD, OR, 97223 Tel: 503.718.2439 Inspection Date: February 10, 2017 at 8:42:19 AM Record ID: ELC2016-00956 Inspector: David Young Contractor