Permit Support Document (22) CITY OF TIGARD ELECTRICAL PERMIT
.1101--- u
Permit#: ELC2017-00150
COMMUNITY DEVELOPMENT Date Issued: 03/02/2017
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6 f } 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 r -, ,; '.0-; Parcel: 2S102AB90006
,t . • Jurisdiction: Tigard
Site address: 9210 SW CENTER ST 6 Ir i 7
Project: House Happy Subdivision: WILLOW BEND CONDO,THE Lot: 6
Project Description: Re-route kitchen circuits,replace ceiling heat with wall fan forced heaters. 3/5/17:REPRINTED permit to add(1)
branch circuit for microwave.
Contractor: OMNI ELECTRIC INC Owner: IMPAC FUNDING CORP TR
16670 SW WRIGHT ST BY EDMONDSON, SHARON
BEAVERTON, OR 97007 19500 JAMBOREE RD
IRVINE, CA 92612
PHONE:
PHONE: 503-747-0805
FAX: 503-649-2709
FEES
Quantity Description Date Amount
7 crt Branch Circuits wo/Purchase 03/02/2017 $100.70
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/02/2017 $12.08
Type of Use: MF Electrical
1 crt Branch Circuits w/Purchase 03/15/2017 $7.42
Class of Work: ALT Service or Feeder
Type of Const: 45 Misc Administration Fee 03/15/2017 $45.00
Occupancy Grp: 0 ea 12%State Surcharge- 03/15/2017 $0.89
Electrical
Total $166.09
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. 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 throu h R 952-001-0090. btain rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344./
Issued 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 603.639.4175 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
City of Tigard f k Received / Permit#:
- ti 1 Date/By: 3 i51/7 !�'1Etk-- -0(7-'()CIS?)
11111 ' q 13125 SW Hall Blvd.,Tigard,OR 97223 � '
-
Phone: 503.7182439 Fax: 503.598.1960 Plan Review
y:
� Related Permit if:
Inspection Line: 503.639.4175 z\ ,; a pate/By: ice: la See Page 2 for
TI G A R D Internet: www.tigard-or.gov c® 1' 11 s :.1444 eNrod: Supplemental Information
TYPE OF WORKk3 PLAN REVIEW
❑New construction ®Addition/alteration/repvicament Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: c¢' _ where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION t exceeds 10,000 amps at 150 volts or 0 Floating buildings.
1:31-and 2-family dwelling 0 Commercial/industrial 0 Auildin
less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.►1 Multi-family 0Master builder 0O r: ❑
Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATIO ❑Emergency system. larger separately derived
Job#: ( Job site address:9210 SW Center St ❑Add100HP o of new motor load of system
00HP or more. ❑"A',"E""1-2""1-3",
City/State/ZIP:Tigard,OR ❑six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: / ( Project name:House Happy 0 Hazardous locations. 0 Supply voltage for more than
�Y ❑Service or feeder 600 amps or more. 600 volts nominal.
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: ( Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea_add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(with above sq.ft.)
Microwave circuit Limited energy,multi-family
L. residential(with above sq.ft.) 75.00 2
Q
`� a � (✓t+rLN1` O t ��` rRenewable Energy ❑ See Page 2
❑ PROPEOWNER ❑' TENANT V 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
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
o APPLICANT - ❑ 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
Address: —56.18 2
_ branch circuit
City/State/ZIP: Each add'l branch circuit i 7.42 7'(,j„ 2
( Miscellaneous(service or feeder not included)
Phone:
( ) 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:Omni Electric Inc Sign or outline lighting 67.84 2
Address:16670 SW Wri ht St Signal circuit(s)or limited energy
0 See Page 2 2
g panel,alteration,or extension.
City/State/ZIP:Beaverton,OR 97007 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)747-0805 , Fax:( ) Investigation(1 hr min) 90.00/hr
Email:omni_electric@hotmail.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is90.00!
hr
CCB Lic.: 176615 I Electrical Lic.: c297 I Suprv.Lic.: 4270s specifically listed('A hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: % Subtotal: t 143,
Print name: John M.Kelso 1.Date: 3/15/17 0 Plan Review Required(25%of permit fee): _
State surcharge(I2%of permit fee): f1
Authorized signature: TOTAL PERMIT FEE: 3.3
This permit application expires if a permit is not obtained within 180
Print name: Date: 3/15/17 days after it has been accepted as complete.
* Number of inspections allowed per permit.
r:1Butiding\Perrnits\ELC PennitApp_ELR ERE.doc Rev 06/17/2015 440-4615T(11/05/COMIWEB