Permit (33) CITY OF TIGARD ELECTRICAL PERMIT
N . . : COMMUNITY DEVELOPMENT Permit#: ELC2017-00473
T[GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/21/2017
Parcel: 2S110BB04300
Jurisdiction: Tigard
Site address: 12300 SW AMES LN
Project: Roth Subdivision: ARLINGTON RIDGE Lot: 20
Project Description: (1)branch circuit for lighting for patio cover.
Contractor: OWNER Owner: ROTH, THERESA D&MICHAEL D
MICHAEL ROTH 12300 SW AMES LN
12300 SW AMES LN TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 503-579-9316 PHONE:
FAX:
FEES
Quantity Description Date Amount
Specifics; 1 crt Branch Circuits wo/Purchase 06/21/2017 $56.18
Service or Feeder
1 ea 12%State Surcharge- 06/21/2017 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports(Conditions)
4
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes andel 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 �wvork is suspended for more the 180
days. ATTE •N: • =.on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Tho rules are set forth in OAR
952-001-0. 0 through OAR %r 1-.0•' You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.187 or 1.802,2344.
Issued :y: �� \, /,`,r JJJ
Permittee Signature: X 6f
OWNER INSTALLATION ONLY
The installation is being made on property I.wn which is not intended for sale,lease or rent.
OWNER'S SIGNATURE �i ,' „! , Date: C/� sg/ /
7 r "/
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 FOR 01•11('E LSI:ONLY
i
City of Tigard s Received �/ [/
• Date/B a/�1'� Permit#: i/!—e /7
III 13125 SW Hall Blvd.,Tigard,OR 97223
a' Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Date/B : Related Permit#: it-i7---9,0/7-t)/9ild
Inspection Line: 503.639.4175 Ready Date/By: Jags;
1 16 A R 1) Internet: www.ti and-or. ov S See Page 2l for
g g Notified/Method: Supplemental information
TYPE OF WORK, PLAN REVIEW
❑New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition El Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or
0 Floating buildings.
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
ID Multi-familyamps for all other installations. buildings.
❑Master builder 0 Other: ❑Fire pump. 0 installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: �� ❑Addition of new motor load of system.
Job site address: /23o W P, y
100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: —77 6,4_,2_,406,,2_ 0722- / ❑Six or more residential units. occupancy.
r f� 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
Cross street/directions to job site:
❑Service or feeder 600 amps or more. 600 volts nominal.
FEE SCHEDULE'
Description I Qty. I ...,Each I Total l
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: - 1,000 sq.ft.or less 168.54 4
Ea.add]500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK
Limited energy,residential
//JS7-4-CCA17 OtC.f OF LlG il r74.t 6 (with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 1 0 TENANT
nA Services or feeders installation,alteration,and/or relocation
Name: / I C f./.4.. L R..0 200 amps or less 100.70 2
Address: /2300 .5 co L�-�LiEs Cwt 201 amps to 400 amps 133.56 2
City/State/ZIP: ?�� q ��[[ 401 amps to 600 amps 200.34 2
04, 7 z4 601 amps to 1,000 amps 301.04 2
Phone:(5-63Q
"�'Tq�— 6 s i� Fax:( ) Over 1,000 amps or volts 552.26 2
Email: 6 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 1
intended for sale, -al.,re A or exc e,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: ' Date: tp—ro l7 401 amps to 599 amps 168.54 2
El APPLICANT I 0 CONTACT PERSON Branch circuits-c new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
Contact name:
each branch circuit 7.42 2
B.Fee for branch circuits without
1 Address: service or feeder fee,first 56.18 ` Q(�
2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Phone: Miscellaneous(service or feeder not included)
( ) I Fax: :( ) Each manufactured or modular
Email: dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 00' �J A 1 c n Sign or outline lighting 67.84 2
Address: I 'lam Signal circuit(s)or limited-energy
panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) I Fax:( ) hr min Investigation(1
€ ) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 1 Electrical Lic.: I Suprv.Lic.: specifically listed C%hr min) 90.00/hr
Suprv.Electrician signature,required: ELECTRICAL FERMIT FEES
Subtotal: tib, /c6
Print name: ` Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): CD, 71
Authorized signaturc.SLf TOTAL PERMIT FEE: /oa>r 92
I Z f /� This permit applicationdaysafterit expireshasbeen if a permitaccepted isas not obtainedcomplete. within 180
(Cr'
Print name: Date:4—ip w
I v --245�7�V I7 * Number of inspections allowed per permit.
1:A Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
I,
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
"c6;.,:"7
�` r#.:## tt Each Total i *
VL :0b: �..�.:. Description
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
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
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
>100 kva-no additional charge 0.0 3
❑ Vacuum Systems*
Each additional inspection over allowable in any of the above:
Each additional inspection is 66.25/hr 1
❑
Other: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(/2 hr min)
` '4TX 1 u at.
O +, 7 84),W L :441.' Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(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
1:\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:
12300 SW AMES LN, TIGARD, OR, 97224 June 26, 2017 at 10:07:38 AM
Record Type: Record ID:
Residential - Electrical ELC2017-00473
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor