Permit (48) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2017-00516
T GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/11/2017
Parcel: 2S 104 BA04200
Jurisdiction: Tigard
Site address: 12474 SW 141ST PL
Project: JONES Subdivision: CASTLE HILL NO.2
Project Description: Altering(1)branch circuit. Lot: 75
Contractor: OWNER Owner: JONES, GORDON A&ELIZABETH D
GORDON JONES 14605 SW WEIR RD
12474 SW 141ST PL BEAVERTON, OR 97007
TIGARD, OR 97223
PHONE: 503-858-4043 PHONE:
FAX:
FEES
Quantity Description Date Amount
Specifics: 1 crt Branch Circuits wo/Purchase 07/11/2017 $56.18
Service or Feeder
1 ea 12%State Surcharge- 07/11/2017 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports(Conditions)
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 ifi 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 . adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. obtain a •.y of the rule or direct questions to OUNC by calling 503.232.1987 or 1.801/332.2344.
Issued By: 1a<p�y
,/'�� 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
City of Tigard Received
U 13125 SW Hall Blvd.,Tigard,OR 972 Date/By: ' /I tC 7 Permit#: f^ i , _r ) t.rr
= Phone: 503.718.2439 Fax: 503.598.1 Plan Review LAN
Inspection Line: 503.639.4175 Date/By: Related Permit#: _ i�L 7
T I G n ft D �`� Ready Date/By: Juris: r J See Pageg/2 for • i
Internet: www.tigard-or.gov 2- Notified/Method. I Supplemental See 2 Informationnr
YPE OF WORK
.\\\
❑New construction ddition/alteration/ c � Ark *` PLAN REVIEW
TTT ^►115101`< Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition 0 Other: lei ❑Service or feeder 400 amps or more
P 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONS17
N exceeds 10,000 amps at 150 volts or 0 Floating buildings.
`-1-and 2-family dwelling 0 Commercial/industrialless to
Y 0Accessory building ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
12 Multi-family ❑Master builder 0 Other:
JOB SITE INFORMATION AND LOCATION 0 Fire pump. ❑Installation 150 KVA or
El Emergency system. larger
separately derived
Job#: I Job site address: l / ^T 0 Addition of new motor load of system.
"2` ✓ ( p.J 1001IP or more.
City/State/ZIP: 0"A","E","1-2","1-3"
/�.� / : ��2
0 Six or more residential units. occupancy.
Suite/bldg./apt.#: ❑Health-care facilities. 0 Recreational vehicle parks.
I Prdject name: 7-- 0 Hazardous locations. 0 Supply voltage for more than
Cross street/directions to job Site:
0 Service or feeder 600 amps or more. 600 volts nominal.
FEE SCHEDULE
Description I Qty. I Each l Total I *
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
Limited energy,residential
ctrl 41 'L n L/7"ie; .7—O // (with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
PROPERTY OWNER i ❑ TENANT - Renewable Energy El See Page 2
Name: cio� � Services or feeders installation,alteration,and/or relocation
,j. "tie ., _ 200 amps or less 100.70 2
Address: /.t. ..41 .5 l4i / 1 j i 201 amps to 400 amps 133.56 2
0'
City/State/ZIP: 76,74k1) Q 97 -1.� 2 401 amps to 600 amps 200.34 2
Phone: f� > 601 amps to 1,000 amps 301.04 2
(cg) $✓ 4.0 ,3' Fax:( ) Over 1,000 amps or volts 552.26 2
Email: �y �,�y� ,.�— N�<�.� Temporary services or feeders installation,alteration,and/or
Owner installati This installatioVis beingmade onpropertyrelocation
intended for sale,lease or ex ange .cording to ORS 7,449,670,awhich70 is not 2001 amps toor less 59.365
1
Owner signa
t
201 amps to 400 amps 125.08 2
��+a . _ <' / ,/7 401 amps to 599 amps 168.54 2
0 APPLIC t ►' 0 CONTACT PE O Branch circuits—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
Address: service or feeder fee,first
branch circuit / 56.18 fr) 2
City/State/ZIP: Each add'l branch circuit J
7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( )
Each manufactured or modular
Email: dwelling,service and/or feeder 67.84 2
CONTRACTOR Reconnect only 67.84 2
Business name: 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.Lie.: specifically listed(''/z hr min) 90.00/hr
Suprv.Electrician signature,required: ELECTRICAL PERMIT`'FEES
S�
Print name: Subtotal: 0
Date: 0 Plan Review Required(25%of permit fee): _
State surcharge(12%of permit fee): '7,I
Authorized signature: TOTAL PERMIT FEE: l
IPrint name: This permit application expires if a permit is not obtained within 180
IDate: days after it has been accepted as complete.
I:\Building\Permits\ELC_PermitApp ELR_ERE.doc Rev 06/17/2015 * Number of inspections allowed per permit.
440-4615T(11/05/COM/WEB
Electrical Permit Application–City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
FEE SCHEDULE
RESIDENTIAL WORK°ONLY: Description I Qty. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 100.70 2
5 kva or less
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:
El 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
D 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('h hr min)
ELECTRICAL~PERMIT FEES
COMMERCIAL-WORK ONLY: ^' 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
O Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
O Outdoor Landscape Lighting*
O 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:
12474 SW 141ST PL, TIGARD, OR, 97223 July 12, 2017 at 10:34:14 AM
Record Type: Record ID:
Residential - Electrical ELC2017-00516
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor