Permit (41) CITY OF TIGARD ELECTRICAL PERMIT
. ' COMMUNITY DEVELOPMENT Permit#: ELC2017-00368
T GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/23/2017
Parcel: 2S103CC13200
Jurisdiction: Tigard
Site address: 12076 SW WHISTLER'S LOOP
Project: Rockenstein Subdivision: WHISTLER'S WALK NO.2 Lot: 79
Project Description: (5)branch circuits for wet bar,relocation of laundry plugs&install new lights.
Contractor: THREE DOG ELECTRIC Owner: ROCKENSTEIN, EDWARD&KIRENJEET
5250 SW CAMERON RD. 1413 OWEN DR
PORTLAND, OR 97221 CHULA VISTA, CA 91911
PHONE: 503-246-4726 PHONE:
FAX: 503-246-2113
FEES
Quantity Description Date Amount
Specifics: 5 crt Branch Circuits wo/Purchase 05/23/2017 $85.86
Service or Feeder
1 ea 12%State Surcharge- 05/23/2017 $10.30
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
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 . - 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. •TTENTION Ore..'n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 '001-0010 through OAR 9 -X01-.••a. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232. 7 or 1.800. 32.234 .
I sued By: / I .4 / Permittee Signature: K.
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:
C.,r1,1-
Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Ac �`«ll / /T
LICENSE NO. -/ :7 2 6
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 Applic FOR OFFICE USE ONLY
City of Tigard nECEIVErt Received
11 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: O� /, Permit No.: e(�J !y_,3th�/
Phone: 503.639.4171 Fax: 503. g1x6:IN .
Plan Review
YY a Date/By: Other Permit: I,H y r'l 7-06/7
TI G A R D Inspection Line: 503.639.4175 Mu 4 a L 017 Date Ready/By: Juris: /
Internet: www.ti ard-or. ov I S See Page 2 for
g g ,� �r Notified/Method: Supplemental Information
TY��PyyE-t � IGARD PLAN REVIEW
0 New construction Please check all that apply(submit 2 sets of plans w/items checked below):
0 Demolition 0 Other: 0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTIONexceeds 10,000 amps at 150 volts or
0 Floating buildings.
21'1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑Multi-familyamps for all other installations. buildings.
0 Master builder 0 Other: ['Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of 0"A","E","1-2","1-3",
Job no.: Job site address: 12.01(, 5 W (J-14 I S�L �
vcS I001IP or more. occupancy.
❑Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIPT6 A(LO Q. q 2L.3 LOO ' 0 Health-care facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: 0 Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. 1 Fee. I.. Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 145.15 4
Tax map/parcel no.: Ea.add'l 500 sq.ft.or portion 33.40 1
Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family
ki C t at() fir% 1o2_ tu Iz l Q k2, I Z c{,Loc IAA-A_ residential(with above sq.ft.) 75.00 2
Services or feeders installation,alteration,and/or relocation
L Ki-V w►'NtL N l'L U GS110 -1-Al--(..- kJ VILA-)W L I G lTS-4 • 200 amps or less 80.30 2
0 PROPERTY OWNER I 0 TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
Address: 601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
relocation
Phone:( ) Fax:( ) 200 amps or less 66.85 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 133.75 2
Branch circuits-new,alteration,or extension,per panel
Owner signature: Date:
0 APPLICANTA.Fee for branch circuits with
0 CONTACT PERSON. above service or feeder fee, 6.65 2
Business name: each branch circuit
B.Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 46.85 2
Address: Each add'l branch circuit Li 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular
dwelling, 90.90 2
service and/or feeder
Phone:( ) I Fax: :( )
Reconnect only 66.85 2
E-mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name:-rCJ C c� Signal circuit(s)or limited-
`, I-II l e-I L energy panel,alteration,or
Address: S 2c O s . (�. C c X20 k,,, , extension.Describe: Page 2 2
City/State/ZIP: Po ce_T L IJ t 0 2 0\-. •- It Each additional inspection over allowable in any of the above
Phone:( 3) Li 2_`_ I,{ -(� Fax: ) Per inspection 62.50
3 2.L((,-Z„I ( 3 Investigation per hour(1 hr min) 62.50
CCB Lic.: I'3g S6 ct Electrical Lic.: c t$ Q Suprv.Lic.: 4,(0 t 3 S Industrial plant per hour 73.75
Suprv.Electrician signature,required: ti..._ c ELECTRICAL PERMIT FEES
Subtotal: g5; ?to
Print name: F. 1Z I `^ a_vo %—C Date: 6_ Z b Ft
Plan review(25%of permit fee):
3 . State surcharge(8%of permit fee): (0-,3 d
Authorized signature:
TOTAL PERMIT FEE: 96,/t'
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.doc 05/23/06 440-4615T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2- Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
• Garage Door Opener*
ID Heating,Ventilation and Air Conditioning System*
O Vacuum Systems*
0 Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918-260-260)
Check Type of Work Involved: •
O Audio and Stereo Systems
• Boiler Controls
• Clock Systems
• Data Telecommunication Installation
Fire Alarm Installation
• HVAC
El Instrumentation
• Intercom and Paging Systems
• Landscape Irrigation Control*
• Medical
ElNurse Calls
• Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\Building\Permits\ELC-PermitApp.doc 03/23/06