Permit Support Document CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit#: ELC2017-00186
10 .
A D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 c Date Issued: 03/17/2017
-
Parcel: 2S109AA00400
�i /1 7 Jurisdiction: Tigard
Site address: 14101 SW 125TH AVE
Project: TONYA TURNER Subdivision: None Lot: None
Project Description: NEW CIRCUITS;KITCHEN LIGHTING,LIVING ROOM LIGHTS&PLUGS.ALTERED CIRCUITS;KITCHEN
PLUGS, KITCHEN/DINING PLUGS, MICROWAVE,COFFEE MAKER,KITCHEN ISLAND PLUGS, BACK DECK
LIGHTS&GFCIS,GARAGE/LIVING RM LIGHTING,DINING ROOM LIGHTING,MASTER BEDROOM LIGHTING,
Contractor: MIKE'S ELECTRIC Owner: TURNER,JAMES R&TANYA L
11070 SW ALLEN BLVD 14101 SW 125TH AVE
BEAVERTON, OR 97005 TIGARD, OR 97224
PHONE: 503-649-6991 PHONE:
FAX: 503-641-1902
FEES
Quantity Description Date Amount
13 crt Branch Circuits wo/Purchase 06/21/2017 $145.22
Specifics: Service or Feeder
1 ea 12%State Surcharge- 06/21/2017 $17.43
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $162.65
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 R 952-001-0090. - opy• the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
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 roRct�F c)�� ., rt
City of Tigard atetved LLJ� ! V�� �
Date/By: Permit (J
M
13125 SW Half 3Rd..Tigard.OR 97223 JUN 1 2017 Plan Review j
Phone: 503.713 2.139 Pax. 5(13.598.1961) Data/Hy- Related Permit
TI-GAM:1i- Inspection Linc: 503.639.4171 CITY OF TIGARDNRe Date/By: ions Sec Page z for
_ # Internet: Wwt4.t lgard-or.got' �'( otihedt�'Ieihod: Supplemental Information
�— TYPE OF WaikilLDING DIVISION PLAN REVIEW
❑New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans a ilems checked):
E1 Demolition ❑Other: 0 Service or feeder 400 amps or more 0 Building over three stories,
where the available fault current 0\taunt is and heat>ards.
,�� CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 v ohs or 0 Floating Hing buildin
d I-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground.or axe,ads 14.000 0 Conm,cre d-use agricultural
amps for all other installations. buil dints
❑Multi-family 0 Master builder 0 Other: ❑Fire pinup. 0 Installation of 150 h1 A or
JOB SITE INFORMATION AND LOCATION y 0 Emergenw system larger deri,cd
Joh#: .lob site address: It 1 f ry 1 ;etc) izsm f^t ❑.40,,,,O of new motor load of em.
tt 11 V lr t...✓ I(H)NI OE nxtte. ❑ t E"• I I-` 1
City/State/ZIPi ` ❑Six or more residential units. o�npnu).
om"—' i +� i 'I ❑Health-cafe facilities ❑is t cion d veil•le parks
Suite/bldg./apt.#: V Project name Nr'1 r ' �u,t,�y�el .-- ❑Hazardous locations. 0 Supply,what.,for more than
❑Service or feeder 600 amps of more. 000,alts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each i Total I `
New residential single-or multi-family dwelling unit.
Subdivision: Lot 4: includes attached garage.
1.000 sq.R.or less 168.54 4
fax map/parcel#: Ea.add'I 500 sq.II.or rxm ion 33.92 I
DESCRIPTION OF WORK Limited energy,residential ,
NS ---Ab �'� /�. (With above sq.h) •
(���g
p, fix * — Div—, C ►` t kt\A-- Limited energy mtdu tamih
75.00
CVP-
y P residential(with above sq.ft
J
�-"f` Renewable Energy 0 See Page 2 i
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: i 200 amps or less 100.70 '
Address:
201 amps to 400 amps I33.56
401 amps to 600 amps 20)1.:4
City/State/ZIP:
_
641 amps to 1.000 amps 301.04
Phone:( ) Fax:( ) Over 1.000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Entail: relocation
Owner installation:'1 his installation is being made,on property that 1 own which is not 200 amps or less 59,36 i
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 _
❑ APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension, er panel
A.Fee for branch circuits with
Business name: above service or feeder fee.
7.42
Contact name: each branch circuitf "
Q.Fee for branch circuits wtthour
• service or feeder fee.lirst !
Address: 56 I s
branch circuit
Each add'I branch circuit 7.42 rZ
City/State/%I I';
-
Miscellaneous(service or feeder not included)
Phone:( I Fax::( ) Each manufactured or modular
67.84
dwelling,service and/or feeder
i Email:
Reconnect only 67.84
CONTRACTOR 2
Pump or irrigation circle 67:34
Business name: Mollenhauer enterprises DBA Mike's Electric Sign or outline lighting 67 84
' Signal citcuit(s)or limited-energy y
7 ❑ See I age 2
Address:
11070 SW Allen Blvd panel.alteration.or extension.
CitylState,`zIP: Each additional inspection over allowable in any of the above
Beaverton, OR 97005 Additional inspection(1 hr min) 66.25 hr
Phone:t 5031649.6991 Fax:( 503)641.1902 investigation I I hr nun) 90.00r hr
Email: mikeselectric@mikeselectric.biz
Industrial plant 11 hr min) 78.18;hr
Inspections for which no fee is •
y0,00 hr
C C 13 lie.:191094 Electrical i ' .--e6-43--- Suprv.Lie.: 5781 S specificallylisted(!_hr min) J
l ELECTRICAL PERMIT FEES
Suprv. Electrician signature.required: • I Subtotal:
Print name:Douala&R McCauley Date: f
,�//7! 0 Plan Review Required(25°4n of permitpermitlea
ki../.
State surcharge(12%ofpermit feel:
Authorized signature: `"- e�ir''�-- TOTAL.PERMIT FEN:
This permit application expires if a permit is not obtained within 180
Print name: Darryl Molle Auer Date: /f //'7 day's after it has been accepted as complete.
Number of inspections alto„ed per permit.
I.Buildma Permits 514'.PermnAppGLR ERE dor Ree tit,17 1015 440•4oI51(1(.05'COSt WEB
CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT11111
t : Permit#: ELC2017 00186
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 " ' T Date Issued: 03/17/2017
Tit="�fd.C' g Parcel: 2S109AA00400
Jurisdiction: Tigard
Site address: 14101 SW 125TH AVE
Project: TONYA TURNER Subdivision: None Lot: None
Project Description: NEW CIRCUITS;KITCHEN LIGHTING,LIVING ROOM LIGHTS&PLUGS.ALTERED CIRCUITS;KITCHEN
PLUGS,KITCHEN/DINING PLUGS,MICROWAVE,COFFEE MAKER, KITCHEN ISLAND PLUGS,BACK DECK
LIGHTS&GFCIS,GARAGE/LIVING RM LIGHTING,DINING ROOM LIGHTING,MASTER BEDROOM LIGHTING,
Contractor: MIKE'S ELECTRIC Owner: TURNER,JAMES R&TANYA L
11070 SW ALLEN BLVD 14101 SW 125TH AVE
BEAVERTON, OR 97005 TIGARD, OR 97224
PHONE: 503-649-6991 PHONE:
FAX: 503-641-1902
FEES
Quantity Description Date Amount
13 crt Branch Circuits wo/Purchase 06/21/2017 $145.22
Specifics: Service or Feeder
1 ea 12%State Surcharge- 06/21/2017 $17.43
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $162.65
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 S 52-001-0090. You ma o• a copy• the rules• direct questions to OUNC by calling 503.23 7 or 1.800.332.2344. r
Issued By: —�� ' Permittee Signature: C
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.
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14101 SW 125TH AVE, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Electrical ELC2017-00186
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor