Permit (35) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2017-00456
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/19/2017
t ` g Parcel: 1S134CD07400
Jurisdiction: Tigard
Site address: 11680 SW TIGARD DR
Project: Brenneman Subdivision: BURLWOOD NO.3 Lot: PTS 33
Project Description: (1)panel and(2)branch circuits.
Contractor: HOLLYWOOD LIGHTS, INC. Owner: BRENNEMAN, HEIDI E&KEVIN T
5251 SW MCLOUGHLIN BLVD. 11680 SW TIGARD DR
PORTLAND, OR 97202 TIGARD, OR 97223
PHONE: 503-232-8855 PHONE:
FAX: 503-232-8505
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 06/19/2017 $100.70
Specifics: amps or less
2 crt Branch Circuits w/Purchase 06/19/2017 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 06/19/2017 $13.86
Electrical
Type of Const:
Occupancy Grp:
Total $129.40
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 i ccordance 'th 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. TENTION: Orego I quj.r.ks you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 1-0010 through OAR 9 -001001 ou may obtain of the rules or direct Permittee Signature:estions to OUNC by
or 1.800.332.234 .
I sued By:
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:
CONTi CTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' 9 ► , Date: (//9//e7
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. '"CEIVEP
IOR OFFI( i I sl.Oyl.l
Cityof Tl and Received /_ff�� Permit#: `(�cao/7-t' I/5-(a Date/B Cl
;, - U 13125 SW Hall Blvd.,Tigard,OR 9,7 � �t r Plan Review
Phone: 503.718.2439 Fax: 503.5 01 9 201/ Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Juris: la See Page 2 for
T I G A R D Internet: CITY Of ��
d-or. ov It�f��.�www.ti anNotified/Method: Supplemental Information
g g
TY' �iI Dl Y ISJQ PLAN REVIEW
!� Please check all that apply(submit 2 sets of plans w/items checked):
❑New construction %Addition/alteration/replacement
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITES INFORMATION AND LOCATION 0 Emergency system. larger separately derived
,` ❑Addition of new motor load of system.
Job#: Job site address: 1 I (� 600 5G4-) T-I sC�C) 5 r 100HP or more. ❑"A","E",`°l-2 °°1-3",
City/State/ZIP: l l Gy t v 9 7E0 ❑Six or more residential units.
0 occupancy.
Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: 51,x; I ((,2' FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: 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
(with above sq.ft.) 75.00 2
�N7q [ �1 X12, /y\>i l ti j(F�L Limited energy,multi-family
C LIIn 1 l`5 Q� ��'' residential(with above sq.ft.) 75.00 2
IA 'MRenewable Energy 0 See Page 2
0 PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 1 100.70 t oi..70 2
Address: 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:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: 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 exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
APPLICANT I ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
0A.Fee for branch circuits with
Business name: "C-\ .\`�v..),LCC.. \ +�1,.'� above service or feeder fee, 1 7.42 U 2
� a� each branch circuit L_ (
Contact name: \�c.C\ pv B.Fee for branch circuits without
Address: 5
1-9 ( 5Q- IN`L-1 ucL, 1 J J service or feeder fee,first 56.18 2
J ` 1;�i branch circuit
City/State/ZIP: cop--)c , be- (\'72 1 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 5 v3) 'L 3 Z. - C(o u( Fax: :( ) Each manufactured or modular
67.84 2
Email: Idwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 1 O(1 J w zc1 1 i 'k-i J Sign or outline lighting 67.84 2
S Signal circuit(s)or limited-energy
Address: C 2-5 ( 5 E irn i-i U u�1�l\,4 9(u C/ panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: l� (ham�g th -? /) Each additional inspection over allowable in any of the above
1(�a i / Additional inspection(1 hr min) 66.25/hr
Phone:( 503) 'l 3.L..- Gj o U 1 Fax:( O) ) 23 Z it)-QS Investigation(1 hr min) 90.00/hr
Iq _ 1 r Industrial plant(1 hr min) 78.18/hr
Email: �U> h"I C� KD�I u 9 tai \�J a 1J 1 Z Inspections for which no fee is 90.00/hr
CCB Lic.:'"1 c6i t)C� Electrical lLLie.: (4,-(,.73 LI Suprv.Lic.: 5 lo i S specifically listed('/hr min)
4 ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ISubtotal: 5-.51-/.
Print name: g0 b4 A4 uj-CoLDate: 0(0.- I-I, i ' 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 13, e(D
Authorized signature: TOTAL PERMIT FEE: k 2 i.`0
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_PemtitAppELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
I
Fee for all residential systems combined: $75.00 Description Qty. Each Tont
3' Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
El 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
50.01 to 100 kva 552.26 2
❑ Garage Door Opener*
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
El Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
El Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specificall listed C/2 hr min)
COMMERCIAL WORK Y
ELECTRICAL PERMIT
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11680 SW TIGARD DR, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Electrical ELC2017-00456
Inspection Type: Inspector:
115 Electrical service Jeff Grove
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor