Permit CITY OF TIGARD ELECTRICAL PERMIT
1 COMMUNITY DEVELOPMENT Permit#: ELC2017-00004
-t-r i_;;y l 1-y 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/03/2017
Parcel: 1 S 125DD06800
Jurisdiction: Tigard
Site address: 9565 SW VENTURA CT
Project: HART Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 76
Project Description: Extending(3)branch circuits.
Contractor: CARRICK INC Owner: HART, SHAUN&MACKENZIE
4875 NW KAHNEETA DR 9565 SW VENTURA CT
PORTLAND, OR 97229 TIGARD, OR 97223
PHONE: 503-334-6005 PHONE:
FAX: 503-645-8273
FEES
Quantity Description Date Amount
Specifics: 3 crt Branch Circuits wo/Purchase 01/03/2017 $71.02
Service or Feeder
1 ea 12%State Surcharge- 01/03/2017 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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. You al- •. .'n a co• of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ifer Permittee Signature:
4110
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 , FOR of ilei l sl. o\I.l
City of Tigard ' t A. Received
4 s " DateB ® � Permit#: 4'-y r ! I( y�-y1
13125 SW Hall Blvd.,Tigard,OR 9 x, ;,..�`' r-c✓ —OLW
_' Phone: 503.718.2439 Fax: 503.59 ,r- Plan Review
DateB : Related Permit#:
Inspection Line: 503.639.4175
T I G A R U , k;' Ready Date/By: Anis: ® See page 2 for
Internet: www.tigard-or.gov Notified/Method: 77& Supplemental Information
TYPE OF"WORK' ~ _Giit
PLANttEl'IE i
0 New construction ®Addition/alteratiot repklalcement,-,,Vi.: _ l''; Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition ❑Servide or feeder 400 amps or more 0 Building over three stories.
❑Other: P
CATEGORY CO where the available fault current 0 Marinas and boatyards.
exceeds 10,000 amps at 150 volts or 0 Floating buildings.
sa 1-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.
12 Multi-family 0 Master builder
Other: 0 Fire pump 0 Installation of 150 KVA or
JOB SITE INFORMATION AND,LOCATION 0 Emergency system. larger separately derived
t ❑Addition of new motor load of system.
Job
Job#: site address:9565 SW Ventura Ct
100HP or more. ❑"A""E> "1-2""i-3>
City/State/ZIP:Tigard 97223 0 Six or more residential units, occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
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:
FEE SCHEDULE
Description I Qty, I Each 1 Total 1
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
DESCRIPTION OF WORK Limited
add'l 500 sq.ft.or portion 33.92 1
Limited energy,residential
install or extend 3 circuits (with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
El PROPERI Y OAR [I' CENANT Renewable Energy
0 See Page 2
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:( ) 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
0 APPLICANT 0 CONTACT PERSON Branch circuits—.newtsalteration,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 56.18 2
branch circuit
City/State/ZIP: Each add'1 branch circuit 2 7A2 14.84 2
Phone: Miscellaneous(service or feeder not included)
( ) 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:Carrick Inc Sign or outline lighting 67.84 2
Address:4875 NW Kahneeta Dr Signal circuit(s)or limited energy
panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP:Portland Or 97229 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)591-8474 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 120169 Electrical Lic.: 34-439C Suprv.Lic.: 2295S specifically listed(%,hr min) 90.00/hr
Suprv.Electrician signature,required: ELECTRICAL PERMITFEES
Subtotal: 71.02
Print name: Doug Carrick Date: 12-28-16 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): : :r
Authorized sig1
e: TOTAL PERMIT FEE: .,.....3-7172-71..5iy
Print name: r This permit application expires if a permit is not obtained within 180
Date: 12-28-16days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC permit&,p_ELR ERE.doc Rev 06/17/2015 440-4615T01/05/COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9565 SW VENTURA CT, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Electrical ELC2017-00004
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor