Permit (11) 111 q
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2017-00418
Date Issued: 06/07/2017
TIGARD
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1S136CB03100
Jurisdiction: Tigard
Site address: 11265 SW 83RD AVE
Project: Pimentel Subdivision: STEVE&HUGHIE'S PLACE Lot: 3
Project Description: Replace 200 amp service and(1)branch circuit.
Contractor: PIMENTEL, MARK Owner: PIMENTEL, MARK
11265 SW 83RD AVE 11265 SW 83RD AVE
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503-705-0321 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 06/07/2017 $100.70
Specifics: amps or less
1 crt Branch Circuits w/Purchase 06/07/2017 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 06/07/2017 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through e'- 95 e. -0091 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
i ..
Issued By: r Gam — Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I ownwwhich is not intended for sale,lease or rent.
./OWNER'S SIGNATURE ' 7"'', °� ° Date: /2/j 7
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
WI
Electrical Permit Application RECEIVE I FOR OFFICE USE ONLY
City of Tigard 7 7 ir'),E):vee!i‘e;laiiina
�y� 7JUN 2011 Penmit#EL•61.`ei' `ev vim13125 SW Hall Blvd.,Tigard,OR 97223
B :
Phone: 503.718.2439 Fax: 503.598.196 Related Permit 5:
Inspection Line: 503.639.4175 (bITY OF TIGARD ADDate/ate/ Date/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISI I INotified/Method: Supplemental Information
�:: rx,-. .:.PLAN REVIOV i
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sers of plans w/items checked):
❑ Demolition
0 Other ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current ❑Marinasandboatyards.
OATEGOR'oF CON$Titue IQ c , `" exceeds 10,000 amps at 150 volts or ❑Floating buildings.
El I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less ro ground,or exceeds 14,000 ❑Commercial-use ag icnitural
amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑Other:
0 Fire pump. 0 Installation of ISO KVA or
' 41:;00' ITT Ii ft 143*Iffi wT AI D L CA131f1 ,,, , ❑Emergency system. lar ger se aratel derived
�c: b P Y
Job 4: Job site address: 11265 SW 83rd Avenue ❑Addition of new motor load of system.
100HP or more. ❑"A","E","1-2","I-3",
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.4: Project name: ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more 600 volts nominal
Cross street/directions to_job site:Pfaffle Street is nearest cross street. -ECHEf17LE .1 _,, • .`,
Description I Qty. I Each Total r*
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel 4: 1,000 sq.ft.or less 168.54 4
'_ .N.,,,,..---.1,1. DE (RIPTIO OF RI LLimitedadd500 y,sqesft.or portion 33.92 I
` �.. energy,residential
Federal Pacific panel change to 100 Amps main breaker panel.
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
•4A4—A/d"s/ C--// ^t-/ �C e__. n residential(with above sq.ft.)
►. P120PO4T OWtsItR Renewable Energy
, ❑ See Page 2
'>'ENATT-2* Services or feeders installation,alt ration,and/or relocation
Name: Mark Pimentel 200 amps or less 1 100.70 100.70 2
Address: 11265 SW 83rd Avenue 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,OR 97223 601 amps to 1,000 amps 301.04 2
Phone:(503)705-0321 Fax:( ) Over 1,000 amps or volts 55226 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
intended for sale, lease,rent,or ex h7e according to ORS 447,449,670,and 701 201 amps to 400 amps 125.08 2
Owner signature:—,,.." Date: 6177//2 401 amps to 599 amps 168.54 2
❑, APPeiCik `1`, y L Branch circuits-:i
new,alteratioi1 or ension,per panel
` ., ..,�' ., (�'",Cb)�I`I`ACT PERSt)N �:I 7 'aryl J
A.Fee for branch circuits withcc ?
Business name: above service or feeder fee, 7.42
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder tee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
Email: dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
GONTRAtOt ....' ;,' Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
2
Address: Signal circuits)or limited-energy
panel,alteration,or extension. ❑ See Page 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(I hr mi ) 90.00/hr
Email: Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is
90.00/hr Lie.: Electrical Lie.: Suprv. LIC.: specifically listed(h hr num)
S
,,,,,,en .I L;ECTRJCAE"'PERMIT FEES uprv. Electrician signature,required: Subtotal: 108.12
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 42 a %7
Authorized signature: TOTAL 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 ���,d
* Number of inspections allowed per permit.
I_\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-461ST([I/05/COM/WEB
`t 4
ft
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORKONLY; ... FE.g $CHEI4LLE
Description I Qty. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 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 2
with OAR 918-309-0040) 552.26
❑ Heating, Ventilation and Air Conditioning
Solar generation systems in excess of 25 kva:
System*
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
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/s hr min)
COMMERCIAL. O .R. (NL` Via.. > cT PEANUT F1ES
Fee for each commercial system: $75.00
Subtotal(Enter on Page I):
* Number of inspections allowed per penult.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
h\Building\Permits\ELC_PerrnitApp_ELR_ERE.doc Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11265 SW 83RD AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Electrical ELC2017-00418
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor