Permit Support Document (28) CITY OF TIGARD ELECTRICAL PERMIT
.1111
COMMUNITY DEVELOPMENT � Permit#: ELC2017-00144
` Date Issued: 03/02/2017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ;
action: 2Tigard Jurisdiction: Tigard
Site address: 9210 SW CENTER ST 1
Project: House Happy Subdivision: WILLOW BEND CONDO,THE Lot: 1
Project Description: Re-route kitchen circuits,replace ceiling heat with wall fan forced heaters. 3/15/17: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: 503-747-0805 PHONE:
FAX: 503-649-2709
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 03/02/2017 $100.70
Specifics: amps or less
7 crt Branch Circuits w/Purchase 03/02/2017 $51.94
Type of Use: MF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 03/02/2017 $18.32
Electrical
Type of Const: 0 ea 12%State Surcharge- 03/15/2017 $6.74
Occupancy Grp: Electrical
1 crt Branch Circuits w/Purchase 03/15/2017 $7.42
Service or Feeder
0 ea 12%State Surcharge- 03/15/2017 $-5.85
Electrical
45 Misc Administration Fee 03/15/2017 $45.00
Total $224.27
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 R 952-001-0,. n..may btain a co of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
�'
Issued By: i Permittee Signature: /`./i'4/2.41 '
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 _,.'- 10 R O 1 1 R I l `,1- O y I \
City of Tigard ;V, Date/B . ,�,� _
EEMI
Received
n 13125 SW Hall Blvd,Tigard,OR 97223 ��� �� Related Permit 4:
h Ian Review
_ Phone: 503.7182439 Fax: 503.598.1960 ,. , ,., % :
Inspection Line: 503.639.4175 . ,.,,,...1; 'crit M ltea{7y Date/By: lilMil H See Page 2 for
T I G A R D Internet: www.tigard-or.gov . % n ^ a ,IN ? Waffled/Method: Supplemental Information't
TYPE OF'WORKIN-t .,y. , PLAN REVIEW
❑New construction ®Addition/alteratian/tt placement Please check all that apply(submit 2 sets of plans wttems checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition Other:
❑ t I B'1 current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION 1`
exceeds 10,000available where the ampsfatt150 volts [3 or Floating bindings
❑ 1-and 2-family dwelling 0 Commercial/industrial ❑A, t•. t aiding
less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. btu-Wings.
®Multi-family 0 Master builder 0 Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SCFE INFORMATION AND LOCATION 0 Emergency mem- larger separately derived
Job#: I Job site address:9210 SW Center St ❑1001Addi1?orn moref .motor load of system.
100HP more. ❑"A,"E","t-2","1-3",
City/State/ZIP:Tigard,OR ❑Six or more residential units. occupanCy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name:House Happy 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 I Total
New residential single-or multi-family dwelling unit,
Subdivision: I 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 75.00 2
‘2614:14-
�� /6
.'-.-"261residential(with above sq.R.)
4.'t 6t tr�,"1� C)e .1 v' lee/VI/ Renewable Energy 0 See Page 2
0 PROPER OWNER NANT 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
0 APPLICANT I 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
n_ .
branch circuit
Address: X6.7 8 2rt
City/State/ZIP: 3 Each add'!branch circuit 1 I 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
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
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address:16670 SW Wright St 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@hotmaiLcom Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is90.00/
hr
CCB Lic.: 176615 Electrical Lic.: c297 Suprv.Lic.: 4270s specifically listed(%S hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ....,‘ Subtotal: -i-itr3;2.4--
Print name: John M.Kelso Date: 3/15/17 0 Plan Review Required(25%of permit fee):
State surcharge(I2%of permit fee): ! , PI
Authorized signature: TOTAL PERMIT FEE: ;]�S 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.
L:\Bulding\Permits\ELC_PernritApp_ELR ERE.doe Rev 06/17/2015 440-4615T(11/05/COM/WEB