Permit (120) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2017-00078
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/02/2017
Parcel: 1 S 133CA03000
Jurisdiction: Tigard
Site address: 13791 SW ANNA CT
Project: Cole Subdivision: GABRIEL WOODS Lot: 9
Project Description: Electrical reconnect only
Contractor: N/A Owner: KELLI COLE
3347 NE SISKIYOU ST
PORTLAND, OR 97212
PHONE: PHONE: 503-288-8821
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 02/02/2017 $67.84
Specifics:
1 ea 12%State Surcharge- 02/02/2017 $8.14
Type of Use: SF Electrical
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports(Conditions)
This permit i -- ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done accordance wi 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 :w ire ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-f 01-0010 through OAR 952-r r 1-0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.23 187 or 1.800.3 2.2344.
f�
Is.ued By: ' \`� •� 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.
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.
�� cry o,"—r a1 �b
Electrical Permit Application Project# a��l/7
Washington County,155 N.lar AV,Suite 350,MS 12,Hillsboro,OR 97124,7 O�
[c:leloT Phone:503-846-3470,Fax:503-846-3993/lutbld co.washin on.or.us
g@ � Permit#
Inspection Requests:503-846-3699/www.co.washington.or.us/piro
TYPE OF WORK PLAN REVIEW
❑Nevu ct�' Addition/alteiation/replacement Other: Please check all that apply:
���
vi K e(.g.pt�C
0 Service or feeder 400 amps 0 Hazardous locations
a 7(} or more where the available 0 Service or feeder 600 amps or more
CIATEGORY OF CONSTRUCTION 0 Building over three stories
F fault current exceeds
❑ 1-and 2-family dwelling -[ rowtmercial/industrial 0 Accessory building 10,000 amps at 150 volts or❑ Marinas and boatyards
less to ground,or exceeds
❑Multi-fat j,l+ ., 0 Master builder
i ‘,„..it. ❑Other: 14,000 amps for all other 0 Floating buildings
� , JOB SITE INFORMATION AND LOCATION installations. ❑ Commercial-use agricultural
buildings
Job no.: Job address: , 3,qj f W ,Q-_�Q 0 Emergency system 0 Installation of 150 KVA or larger
J 1•` o Fire pump
separately derived system
City/State/ZIP: ❑ Addition of new motor
iia(A 0 '11223 load of 100HP or more E] .A,»"E,".q-2,""1-3"occupancy
❑ Recreational vehicle parks
Suite/bldg./apt.no.: Project name: 0 Six or more residential units
Q ❑ Health-care facilities ❑ Supply voltage for more than
Cross street/directions to job site: et V1AD1...,s f1�,' 600 volts nominal
'
FEE SCHEDULE
Description Qty. Fee Total *
Subdivision: G Q to r'1 e14 1 . t Lot no.: Gi Residential single-or multi-family dwelling unit.
�/��� Includes attached garage.
Tax map/parcel no.: i 5, 3 3 4_A/ 030 ,0 1,000 sq.ft.or less 167.00 4
DESCRIPTION OF WORN Ea.add'l 500 sq.ft.or portion 47.00
F�- Limited energy,residential 107.00 2
t vir1 Cit i{ ee(--ovL✓tech v1 C>{r_.,A4.1 (with above sq.ft.)
Limited energy,multi-family 107.00 2
w�( residential(with above sq.ft.)
l PROPERTY OWNER ❑ TENANT Seyrvicea or feeders installation,alteration,and/or relocation
Name: /�� C‘,1'
' 200 amps or less 107.00 2
C 11 l 201 amps to 400 amps 161.00 2
Address: 3 3 41 N E Si s k`.b (1 401 amps to 600 amps 214.00 2
601 aCity/State/ZIP: T ,,,,--11„,,,,,,, Q q 7212 1,1,0s0000to amps1,00amps 321.00 2
Over or volts642.00 2
Phone:(51,3) Zz,6 862.4 Fax:( ) Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on residential or farm property owned by me or a member of 200 amps or less 107.00 2
my immediate family. This pro tty is not intended for sale,exchange or rent.(ORS 479.540(1)and 479.560(1).
• CSI ot-/ft_Q 201 amps to 400 amps 161.00 2
Owner signature: �.�(iLc> l Dater 3C j� 401 amps to 599 amps 214.00 2
0.APPLICANT CONTACT PERSON Branch;circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: b d+ti vii above service or feeder fee, 9.50
Contact name: T
each branch circuit 2
k.J I‘z,,,,,Il,t ✓-,.tx,T B.Fee for branch circuits
Address: 6'1 C7 without service or feeder 107.00
b S l.�l CMC!�.S fLliti�r fee,first branch circuit 2
City/State/ZIP: 002_ ` Each add'I branch circuit 9.50
q ��� Miscellaneous(service or feeder not included)
Phone:(Sb3) &b3 (,,i v Fax:( ) Each manufactured or modular
�,,// 1 dwelling,service,and/or feeder 113.50 2
E-mail: CrU ek v\IA€ ( e 0 L11 C K 7� 4/3T. L v LAN
Reconnect only k 107.00 1
NTRACTOR Pump or irrigation circle 107.00 2
Business name: /cI/,1/' Sign or outline lighting 107.00 2
1 Signal circuit(s)or limited-
Address: energy panel,alteration,or
extension.Describe: 107.00
City/State/ZIP: 2
Phone:( ) Fax:( ) Each additional Inspection over allowable In any of the above
Per inspection 107.00
E-mail: CCB lic.no.: Investigation fee(See compliance)
Electrical lic.no.: City or metro lie.: Other:
Supervising electrician ELECTRICAL PERMIT FEES
signature,required: Subtotal / 0-7 o r
Print name: Date: Plan review(25%of permit fee)
Authorized State surcharge(12%of permit fee) . eq
signature: TOTAL PERMIT FEE I -1 ,Jy
Print name: This permit application expires if a permit is not obtained
Date: within 180 days after it has been accepted as complete
` llnber of inions allowed per permit. Revision 6/13
y.o 475- Y4
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
13791 SW ANNA CT, TIGARD, OR, 97223
Record Type:
Residential - Electrical
Inspection Type:
115 Electrical service
Result:
FA I L
Comments:
Tel: 503.718.2439
Inspection Date:
February 6, 2017 at 9:24:37
AM
Record ID:
ELC2017-00078
Inspector:
David Young
Fix light in upper level bedroom hanging from wire nuts.
Replace missing switch plate in upper level bedroom.
All else ok.
Re schedule as electrical final inspection.
Violation Summary:
Inspector Contractor
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
13791 SW ANNA CT, TIGARD, OR, 97223
Record Type:
Residential - Electrical
Inspection Type:
199 Electrical final
Result:
PASS- NoCofO
Comments:
Final approved for electrical re connect.
Violation Summary:
Tel: 503.718.2439
Inspection Date:
February 14, 2017 at 8:53:08
AM
Record ID:
ELC2017-00078
Inspector:
David Young
Inspector Contractor