Permit (42) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2017-00305
F - .�'`
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/01/2017
T f �'"� ° Parcel: 1 S 136AA 13200
Jurisdiction: Tigard
Site address: 10335 SW 67TH AVE
Project: WALTER Subdivision: OAK STREET ESTATES Lot: 27
Project Description: (4)branch circuits for electrical remodel.
Contractor: OWNER Owner: WALTER, SUSAN L&RONALD T
RON WALTER 10335 SW 67TH AVE
10335 SW 67TH AVE TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-519-9978 PHONE:
FAX:
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo/Purchase 05/01/2017 $78.44
Specifics: Service or Feeder
1 ea 12%State Surcharge- 05/01/2017 $9.41
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 obtain a coon of the rules or direct questions to OUNC by calling .1987 or 1.800.332.2344.
Issued By: Permittee Signature:
/if
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 FOR OFFICE USE ONLY
Cl ofTigard ReceivedL- `5b 111��� Date/By: r/ l� 7 .sj'I -IIMIEN
'� 13125 SW Hall Blvd.,Tigard,ORce,.‘NeoPlan Review
Phone: 503.718.2439 Fax: 503.59 '- +� Date/By: Related Permit#:
Inspection Line: 503.639.4175 1201 Ready Date/By: El See Page 2 for
TIGARD Internet: www.tigard-or.gov MPSyt"p Notified/Method. lrhMIII Supplemental Information
TYPE OF WOW ` link l' N PLAN;I Evr u .%%
❑New construction Er Addition/alteratRldrr1!` Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
jg 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family ❑Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AN .,OCATION' ❑Emergency system. larger separately derived
ElAddition of new motor load of system
Job#: Job site address: (C -s ,..5.,„,) -1T 1-f A,0looHP or,Wore. E","1-2","1-3",
❑Six or more residential units. occupancy.
City/State/ZIP: "'� �' i�I�b �}� CA-7-2.z.;
❑Recreational vehicle parks.
� ❑Health-care facilities.
Suite/bldg./apt.#: Project name: ❑Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: 0 r-t ts '" FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: V it pc cAecT 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.)
6t) •z44/.1, Lt/44.•r /S -kTf yerev Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
PROPERTY-OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 1' L0 PtL 200 amps or less 100.70 2
Address: 5A 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:(5-C,3)-519 19 -C19 7 8 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: r i,1/4.:c.,‘ r cL TorA rA �i kj(Cl ,,CC)hid relocation
Owner installation:This installation is being made on property thaT1 own which is not 200 amps or less 59.36 1
intended for sale,14s. ent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
g i 1 --/ 7 401 amps to 599 amps 168.54 2
Owner signature: L Date:
Branch circuits—new,alteration,or extension,per panel
®_APPLICANT CONTACT PEI2SQtT
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: o B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 56./6j 2
branch circuit
City/State/ZIP: Each add'l branch circuit 3 7.42 22_.Z4 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: Sign or outline lighting 67.84 2
Signal circuit(s)
Address: panel alte ation,00r er mtension�r� ❑ See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr mm) 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('/z hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal: 7 „lig{
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 9„,i i
Authorized signature: TOTAL PERMIT FEE: 8 7. i 5
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.
1:\Building\Permits\ELC_PermitApp_ELR_ERE doc Rev 06/17/2015 440-4615T(1 I/05/COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10335 SW 67TH AVE, TIGARD, OR, 97223 August 14, 2017 at 10:56:15
AM
Record Type: Record ID:
Residential - Electrical ELC2017-00305
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor