Permit (129) CITY OF TIGARDilli ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2017-00264
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/18/2017
Tf i3a1 f g Parcel: 25101 DB00706
Jurisdiction: Tigard
Site address: 7480 SW VARNS ST
Project: GILLETTE Subdivision: ROLLING HILLS Lot: 26
Project Description: (2)branch circuits for kitchen remodel.
Contractor: OWNER Owner: GILLETTE, REED T&ANDREA L
REED&ANDREA GILLETE 7480 SW VARNS ST
7480 SW VARNS TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-334-5657 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 04/18/2017 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 04/18/2017 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through 52-001-009 obtain a the rules or direct questions to OUNC by calling 503.23 1 87 or 1.800.332.2344.
Issued By: t— Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application l O R O F F I C E t SE()NEN
City of Tigard Received
,, ;y_ 4/ 7'f,7 Permit#: a.4.01.)/
`` 7
lig
■ 13125 SW Hall Blvd.,Tigard,OR 97223 evie� ` „,...a42
� . Y
Phone: 503.718.2439 Fax: 503.598.1960i,VCON 1 y. Related Permit#:r, C Zr)i(g. 1 }
Inspection Line: 503.639.4175Ready Date/By: runs: H See Page 2 for
fIC 1 R U Internet: www tigard-or.gov Notified/Method: .iC,i Supplemental Information
TYPE OF WORK NpR 1$ 2011 PLAN REVIEW
El New construction ®Addition/alteration/replacen ent �eT-s I as
( Please check all that apply(submit 2 sets of plans w/items checked):
gilIS ❑Service or feeder 400 amps or more 0 Building over three stories.tY
El Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
�
CATEGORY OF CONSTRUCTI D}%D- •_S1°� exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-familydwellingCommercial/industrialso buildingless to ground,or exceeds 14,000 ❑Commercial-use agricultural
0 ry amps for all other installations. buildings.
o Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AM) LOCATION 0 Emergency system. larger separately derived
❑Addition ofmoew motor load of system.
Job#: Job site address:7480 SW Varns St.
100HP or more. ❑«A,> «E„ <`1-2>, "1-3"
City/State/ZIP:97223 ❑Six or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Kitchen electrical / ❑Hazardous locations. 0 Supply voltage for more than
/6,�t)f �/
Cross street/directions to job site:72'd Ave f ❑Service or feeder 600 amps or more. 600 volts nominal.
FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: J\cl/`h )4,/fs Lot#: ice•' Includes attached garage.
1,000 sq.R.or less 168.54 4
Tax map/parcel#: 1 I b 8 — OC)--)-04,, Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
Alteration/replacement of existing electrical wiring and outlets in kitchen
(with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
® PROPERTY OWNER 0 TENANTServices or feeders installation,alteration,and/or relocation
Name:Reed and Andrea Gillette 200 amps or less 100.70 2
Address:7480 SW Varns St 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:97223 601 amps to 1,000 amps 301.04 2
Phone:(503)334-5657 Fax:( ) Over 1,000 amps or volts 552.26 2
L. Temporary services or feeders installation,alteration,and/or
ii
Email: , 1e`,i L.61 ti a0 r, MC(l t c 0 relocation
Owner installation:This installation is being m de on property that I own which is not 200 amps or less 59.36 1
intended for sale,leas ,rent,o exchange,according to ORS 447,449,670,an 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: Li . 1 7 401 amps to 599 amps 168.54 2
PLICANT ❑ CONTACT PERSON Branch circuits:new,alteration,or extension, ser panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: a /
B.Fee for branch circuits without
G1 �Yl� 6/7/e�"l�
9service or feeder fee,first j 56.18w/
t to 2
Address: 7Y/ 521..) V,u///A SI_ branch circuit /
City/State/ZIP: �•jty,-7 W t- el-7el-72,2,5Each add'l branch circuit / 7.42 1, 1. 2
r Miscellaneous(service or feeder not included)
Phone:( T ) -3'; _cj'7 Fax::( ) Each manufactured or modular 67.84 2
Email: dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: panel,alteration,or extension. g
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(%hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
Subtotal: (fir jj,b 0
Print name: Date: 0 Plan Review Required(25%of permit fee): ----
State surcharge(12%of permit fee): .7, tw'3
TOTAL PERMIT FEE: 7i
Authorized signature:
G 3
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.
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