Permit (52) CITY OF TIGARD ELECTRICAL PERMIT
ry
COMMUNITY DEVELOPMENT Permit#: ELC2017 00385
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/25/2017
TI t � 1 9
Parcel: 1 S 133CA05300
Jurisdiction: Tigard
Site address: 11367 SW HALLMARK TER
Project: Cleveringa Subdivision: BARROWS ROAD ESTATES Lot: 2
Project Description: (1)branch circuit for installation of a/c unit.
Contractor: OWNER Owner: CLEVERINGA, KEITH BRIAN
KEITH CLEVERINGA 11367 SW HALLMARK TER
11367 SW HALLMARK TERRACE TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 408-518-6980 PHONE: 480 518-6980
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 05/25/2017 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 05/25/2017 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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. ATTEN e .. ! -.on lawre(g9uuiiires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0' 0 through OAR•52-00 09
oYou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.80
.332.2 4.
Issue. By: Permittee Signature: 4L�
OWNER INSTALLATION ONLY
The installation is being made on property I own which is n ntend for sale,lease or rent.
OWNER'S SIGNATURE 1 ----.10,7. /�f Date: ,J / ,
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 Applic a E_ r` FOR OFFICE USE ONLY
Received® Permit#: QQ 3?s
City of Tigard i l
B
II u 13125 SW Hall Blvd.,Tigard,OR P 2 21_117 PlanDateR : i 1.— r!
Plan Review
Phone: 503.718.2439 Fax: 503.5 .1960 Date/B Related Permit#:
TIGARD
Inspection Line: 503.639.4175 D Ready Date/By: kris: ® See Page 2 for
Internet: www.tigard-or.gov �CITY� �
Notified/Method: Supplemental Information
TYFROIWRIC DIVISION 7 PLAN'°RE I,gW :.
0 New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRIJCTI,ON exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ I-and 2-family dwelling ❑ Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family 0 Master builder 0 Other:
❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: <1,?..7,i.. ,, `. R • ./ I 00HP or more. ❑"A" "E""I-2" "I-3„
City/State/ZIP: 1/567
51-4
& 4t yy‘ti I-"Ae'-'2-'2-
-p,Q— ❑Six or more resitiential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Ct L f�l.)g/2./,vd„�- ❑Hazardous locations. ❑Supply voltage for more than
❑Service of feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: SClfba6.zS /��O10 j• Fg r S FIEI L r` "
( llescription I Qty. I Each I Total I *
�`" p� New residential single-or multi-family dwelling unit.
Subdivision: !tel Lp M3 Fvt.O C-alltt('v Lot#: Includes attached garage.
Tax map/parcel#: 1., 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.61.or portion 33.92 1
DESCRIPTION OF WORK , Limited energy,residential
75.00 2
A)f_- n . n'1 A& /st4 (with above,sq.ft.))
W/"7� Ll`� Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
PROPERTY OWNER ❑ FNANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
4,....„,r14,
Name: �,,t /1./f t�C,, A 200 amps or less 100.70 2
Address: 1 3( '� v -/-?. s t r�„a1/ y 1 'c ^c.� 201 amps to 400 amps 133.56 2
4'1a"S�- ^'�� 401 amps to 600 amps 200.34 2
City/State/ZIP: j 7 A Ott__ ct- 12.3 601 amps to 1,000 amps 301.04 2
Phone:(ti-s4 5 ( 6?.s d Fax:( ) Over 1,000 amps or volts 552.26 2
�,f Temporary services or feeders installation,alteration,and/or
Email: [
g L' L- C.��,'yi .L, �/Vt 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 iv px., dl o ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: S 123//. 401 amps to 599 amps 168.54 2
0 APPLICANT 0 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: (�
servbranch ice orcircuifeetder fee,fust i 56.18 yC(0t1 2
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwellin 67.84 2
Email: g,service and or teeder
Reconnect only 67.84 2
CON RACTOR Pump or irrigation circle 67.84 2
Business name: (7,6:1,,f; /1* _i2
V(��eSign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy
panel,alteration,or extension. ❑ See Page 2 2
City/State/Z1P: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:
( ) Investigation(I hr min) 90.00/hr
Email: Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is
90.00/hrCCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(L'hr min)
KLWTRICALJ'ERATIT SEP$ f
Suprv.Electrician signature,required:
Subtotal: 5-6..
/$
Print name: Date: 0 Plan Review Required(25%of permit fee): —
State surcharge(12%of permit fee): e,,,.7„/(0AY�
Authorized signature:
i71 hTOTAL PERMIT FEE: � .
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:\Baihting\Permits\SLC_PersstApp_ELR_ERE.,toc Rev 0617/2015 440-4615T(I l/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY:
FEERCREAELE
Fee for all residential systems combined: $75.00 Description 1 Qty. I Each j Total l *
Renewable electrical energy systems:
Check Type of Work Involved: s kva or les 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems*
15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
-leafing, en dation a.. Air C.-•1 1s i
r S ste•
Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
Vacuum Systems* >100 kva—no additional charge 0.0 3
❑ Each additional inspection over allowable in any of the above:
Other: Each additional inspection is
66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is
specifically listed(V2 hr min) 90.00/hr
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT SES
Fee for each commercial system: $75.00 Subtotal(Enter on Page I):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
El Audio and Stereo Systems
I-7 Boiler Controls
❑ Clock Systems
Li Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
Instrumentation
❑ Intercom and Paging Systems
I I Landscape Irrigation Control*
I I Medical
❑ Nurse Calls
I I Outdoor Landscape Lighting*
❑ Protective Signaling
El Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
h\Buitding\Pernuts\ELC_I'etmit App LLR_ERE.doc Rev(16/17'2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11367 SW HALLMARK TER, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Electrical ELC2017-00385
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor