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Permit (166) CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2017-00127 Date Issued: 02/27/2017 -rt ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111CC13800 Jurisdiction: Tigard Site address: 10235 SW HIGHLAND DR Project: MCKEE Subdivision: SUMMERFIELD NO.4 Lot: 189 Project Description: (1)branch circuit to ground panel. Contractor: AC ELECTRICAL CONTRACTOR LLC Owner: MCKEE, CAROL T 5 CENTER POINTE DR SUITE 400 10235 SW HIGHLAND DR LAKE OSWEGO, OR 97035 TIGARD, OR 97224 PHONE: 503-910-3514 PHONE. FAX: 503-845-9633 FEES Quantity Description Date Amount 1 crt Branch Circuits wo/Purchase 02/27/2017 $56.18 Specifics: Service or Feeder 1 ea 12%State Surcharge- 02/27/2017 $6.74 Type of Use: SF Electrical Class of Work: ALT • Type of Const: Occupancy Grp: Total $62.92 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law, All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obt ' f the rules or direct questions to OUNC by calling 503.232.1987jpr 1.800.332.2344. Issued By: _ G} Permittee Signature: dULD ' ryapt QvcS k�r� OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. t Electrical Permit Ap licatioFOR OFFI(E t SI.()NI.) R City of Tigard k 1, Date/B eceived: 13125 SW Hall Blvd.,Tigard,OR 97223 t 40 4$ = g x' '''1'4* t .t. Related Permit#: Phone: 503.718.2439 Fax: 503.598.1960 .. i _`ead Date/By: ® See Page 2 for Inspection Line: 503.639.4175 ,s Y Y 1�G A R p '` Notified/Method: Supplemental Information Internet: www.tigard-or.gov a r." {. TYPE OF WORK ,\IN r '�� PLAN REVIEW Please check all that apply(submit 2 sets of plans w/items checked): ❑New construction acement 0 Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. less to ground,or exceeds]4,000 ❑Commercial-use agricultural 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building amps for all other installations. buildings. 0 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 ❑Addition of new motor load of system. Job#: Job site address:l' ( 23 S s w it t �te, 4 a' 100HP or more. ❑occupancy. 1 0 Six or more residential units. City/State/ZIP: ` *� �� ❑Health-care facilities. ❑Recreational vehicle parks. I 0 Hazardous locations. 0 Supply voltage for more than Suite/bldg./apt.#: I Project name: 600 volts nominal. ❑Service or feeder 600 amps or more. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: I Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 ` (with above sq.ft.) /,, 4 ` �,�? Limited energy,multi-family 75.00 2 �1 ` residential(with above sq.ft.) Renewable Energy 0 See Page 2 0 ,PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 2 201 amps to 400 amps 133.56 2 Address: 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: 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 APPLICANT CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: (5 J 1 .(A) r h- above service or feeder fee, 7.42 2 CCI (A each branch circuit Contact name: Q 4 r: ,gtir( , B.Fee for branch circuitsithout service or feeder fee, 56.18 IC•( b 2 Address: .5_c_,.k,z,S ., R �v t \ e ct c _branch circuit City/State/ZIP: ` Each add'l branch circuit 7.42 2 tY �0.'\{�' �3 Vl% (� © �� Miscellaneous(service or feeder not included) Phone:( j) ax: :( ) Each manufactured or modular 67.84 2 ( t' s-7(..:_t dwelling,service and/or feeder Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 1 + t Sign or outline lighting 67.84 2 Business name: A C ( p C sk,, t,4,3 tc., ,,,1/4L(,_,. L ,C�� L ,— Signal circuit(s)or limited-energy ❑ See Page 2 2 Address: S C L:. ,, —1 f', ...., panel,alteration,or extension. t�' A_' H'`t C": t'1 tEach additional inspection over allowable in any of the above City/State/ZIP:"\s,c \Z�g el..t-A- fC �1 R. Additional inspection(1 hr min) 66.25/hr Phone:(So)) e(1 C: .„. .Ss „. S t ci '( ) Investigation(1 hr min) 90.00/hr Industrial plant(1 hr min) 78.18/hr Email e I c.E, . t ,k C ,u k.a.,\ 0 Y 1,1_<:_, e c ikcp.Q. .k.isInspections for which no fee is 4 661-et, specifically listed('/z hr min) ELECTRICAL PERMIT FEES 90.00/hr CCB Lic. Electrical Lic.: G ® ` Suprv.Lic.: Q� S �+ Subtotal: ` Suprv.Electrician signature,required: ` ' 1 Print name. Ni Date: i 1 Y`-- 0 Plan Review Required(25%of permit fee): �' C3 Vl sst z 1. L l 1 State surcharge(12%of permit fee): 7 s 7 ki TOTAL PERMIT FEE: , co, Authorized signature: 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_ELR_ERE.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 Fee for all residential systems combined: $75.00 Description Qty. Each TotalI * 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: n Burglar Alarm 25.01 to 50 kva 301.04 2 ❑ Garage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 ❑ Heating,Ventilation and Air Conditioning * Solar generation systems in excess of 25 kva: System Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva-no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ 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(1/4 hr min) :COMMERCIAL WORK ONLY: ELECTRICAL PERMIT'`FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): (SEE OAR 918-309-0000) * Number of inspections allowed per permit. Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015