Permit CITY OF TIGARD ELECTRICAL PERMIT
I
NCOMMUNITY DEVELOPMENT Permit#: ELC2017 00485
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/28/2017
Tf g Parcel: 2S111CC18000
Jurisdiction: Tigard
Site address: 10400 SW HIGHLAND DR
Project: Burch Subdivision: SUMMERFIELD NO.4 Lot: 231
Project Description: Adding(1)dedicated circuit for refrigerator and alter(3)branch circuit for additional lighting.
Contractor: OWNER Owner: MIKE&SANDIE BURCH
MIKE&SANDIE BURCH 10400 SW HIGHLAND DR
10400 SW HIGHLAND DR TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 503-781-0337 PHONE: 503-781-0337
FAX:
FEES
Quantity Description Date Amount
1 ea 12%State Surcharge- 06/28/2017 $7.63
Specifics: Electrical
4 crt Branch Circuits wo/Purchase 06/28/2017 $78.44
Type of Use: SF Service or Feeder
Class of Work: ALT 0 ea 12%State Surcharge- 06/28/2017 $1.78
Electrical
Type of Const:
Occupancy Grp:
Total $87.85
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 applic-•le law. All ,•rk 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 i u-.=ded • ore.t e 180
days. ATTEN %•: •r-••n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Arl s set forth in OAR
952-001-00 •through OAR 9' -0' -**10. •u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1977: /S•i � IND
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Issue.'By: _ / ���r Permittee Signature: . i �.
NER IN ALLATION ONLY
The installation is being made on property • ch' fog -I rent.
OWNER'S SIGNATURE / Date: i .
CONT- ,CTORINSTALLATION 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
rolz t�E,�itI. I sl:t)�l.l
. Ci25 W Tigard RECEIVED Received /��� `�O� qO
13125 S W Hal]Blvd.,Tigard,OR 9 D : (�i Permit#:
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Inspection Line: 503.639.4175 DateB : Related Permit#:
T t' R D JUN 2 8 2017 Ready Date/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov LTA Notified/Method:
TYPE OF N TK OF I1GHRU Supplemental Information
❑New construction ®Addition/a1j ' �/1S!(�N PLAN REVIEW
Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition :
0 Service or feeder 400 amps or more 0 Building over three stories.
CATEGORY OF CONSTRUCTION where the available fault current ❑Marinas and boatyards.
exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® 1-and 2-family dwelling 0 Conunercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑Multi-family ❑Master builderamps for all other installations. buildings.
0 Other: ❑Fire pump.
JOB SITE INFORMATION AND LOCATION ❑largeInstallation at 150 KVA or
0Emergency system. larger separately derived
Job#: I Job site address: /01100 . j f � �� ❑Addition of new motor load of system.
64411:11
,��� IOOHP or more. ❑"A>, «E»"1-2",<`I-3"
City/State/ZIP: 7
tr+�"')1 ae- 9121-Li ❑Hxlt more residential units. occupancy.
Suite/bldg./apt.#: ` ❑Health care facilities. ❑Recreational vehicle parks.
I Project name; (� / Z ❑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. j Each I Total *
Subdivision: New residential single-or multi-family dwelling unit.
I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
DESCRIPTION OF WORK Ea.add'l 500 sq.ft.or portion 33.92 1
<4,!)D(wb ®Eot e4 �.`Aea r-,• Limited energy,residential 75.00/��n dant--7 :�T yL (with above sq.ft.) 2
l 0V Z A 17 I fl( 1 tjz IN Liir isid energy,multi-family
iq.
'�W�l`� ' residential(with above sq.ft.) 75.00 2
0 PROPERTY OWNER ® TENANI Renewable Energy ❑ See Page 2
Name: �r�E /)�,�,i f � �£��� Services or feeders installation,alteration,and/or relocation
£3 prat / 200 amps or less 100.70 2
Address: `fie Y Q 0 Sial C4'441
201 amps to 400 amps 133.56 2
City/State/ZIP: 4L6t,�/j1)i 0� 7J7 Ll 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:(SJ3) ?g I d33 7 I Fax:
( ) Over 1,000 amps or volts 552.26 2
Email: j �� � Lr Temporary services or feeders installation,alteration,and/or
Owner installation:This install. '; relocation
�t ,j m.s 1,n property that I own which is not 200 amps or less
intended for sale,lease, ,r;r7�, , .,.'p, ORS 447,449,670,and 701. 59.36 1
/`' 201 amps to 400 amps 125.08 2
Owner signature: /� Date: 40 . 401 amps to 599 amps 168.54
2
❑ ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,Per panel
Business name: A.Fee for branch circuits with
above service or feeder fee,
Contact name: each branch circuit 7.42 2
B.Fee for branch circuits without
Address: service or feeder fee,first 1 `/
branch circuit 56.18 J!O p 2
City/State/ZIP: Each add'l branch circuit
7.42 2
Phone:( ) I Fax::( ) Miscellaneous(service or feeder not included)
Each manufactured or modular
Email: dwelling service and/or feeder 67.84 2
CONTRACTOR Reconnect only 67.84 2
Business name: Q 6,0._..)1•3 q Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
Address: 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
Phone:( ) Additional inspection(1 hr min) 66.25/hr
I Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
CCB Lic.: Inspections for which no fee is
Electrical Lic.: I Suprv.Lic.: specifically listed(%2 hr min) 90.00/hr
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES
Print name: Subtotal: -ry 2 41/t,
I Date: ❑Plan Review Required(25%of permit fee): ! 3
State surcharge(12%of permit fee): y,y,'�
Authorized signature:
TOTAL PERMIT FEE: q g s-
Print name: I Date: I This permit application expires if a permit is not obtameu wmmu rat,
days after it has been accepted as complete.
I:1Building�Permits�EI C_Pemilt ` Number of inspections allowed per permit.
App_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10400 SW HIGHLAND DR, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Electrical ELC2017-00485
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor