Permit (74) CITY OF TIGARD ELECTRICAL PERMIT
I
COMMUNITY DEVELOPMENT Permit#: ELC2017-00544
Date Issued: 07/24/2017
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S134BD07006
Jurisdiction: Tigard
Site address: 11360 SW COTTONWOOD LN
Project: Holmgreen Subdivision: ENGLEWOOD NO.3 Lot: 231
Project Description: (4)branch circuits for(2)bath remodels
Contractor: SAM HARDING INC Owner: RAMER, DANA P/ELLEN M
19988 SW GASSNER RD 11360 SW COTTONWOOD LANE
BEAVERTON, OR 97007 TIGARD, OR 97223
PHONE: 503-780-6224 PHONE.
FAX: 503-356-9729
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo/Purchase 07/24/2017 $78.44
Specifics: Service or Feeder
1 ea 12%State Surcharge- 07/24/2017 $9.41
Type of Use: SF Electrical
Class of Work: ALT
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 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. AT , ON: Or-.on law -•uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-00 -0010 through OAR 152-z.1-0090. u may obtain a copy of he rules or direct questions to OUNC by calling 503.232.1987l� or 1.800.332,2344.
Iss •d By: �_ �/ , Permittee Signature: �_-' ���� s/,
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 yf�di��7�
SIGNATURE OF SUPR.ELEC' � Date: rL� 7/
LICENSE NO. 3 7 7 3 5
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, • 1 i CEIVEP FOR OF1 1( 1: l Sl: Oyl.'i
* '
City of Tigard Date/Be: � � ','7� Permit#: g�dy,17- fit}' 5 '
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.5 L96 f 4 2017 Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Ju is: liff See Page 2 for
1 IGARD Internet www.ti and-or. ov CITY p Notified/Method: Su lemental Information
g g OFTIGARD PP
T��I PLAN REVIEW
0 New construction AdditfoYJ�Tf a lOtl replace eIl�� Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition /gQ��
0 Service or feeder 400 amps or more 0 Building over three stories.
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-familydwellingless to ground,or exceeds 14,000 0 Commercial-use agricultural
l _ ❑Commercial/industrial ustrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE'INFORMATION;,AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: 11--)1."(4) / ('js_,,�,,, r r�J ❑Addition
00HP o of new motor load of system.
to 11"1 ` 100HP or more. ❑"A","E","1-2",
��� ❑Six or more residential units. occupancy.
City/State/ZIP: .'f) A2� O- / Recreational vehicle
V J / ❑Health-care facilities. 0 parks.
Suite/bldg./apt.#: Project name: N(n 'l.f 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total
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 75.00 2
�7� (with above sq.ft.)
2 C� — O " " '7 S Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
❑ PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 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
IAPPLICANf 0 CONTACT; PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: JLJ,\ 1414,14Thi t4 (kX above service or feeder fee,
7.42 2
each branch circuit
Contact name: r t 2h 4 jp 0 B.Fee for branch circuits without
1J service or feeder fee,first
Address: tqR�• /� C1 -s*a Z,� branch circuit 56.18 2
City/State/ZIP: �i z�� 01�Sr (t Each add'I branch circuit .� 7.42 2
L Miscellaneous(service or feeder not included)
Phone:( i3 `7a, _ /-l07 7e4. Fax: :( ) Each manufactured or modular 67.84 2
Email: „-y r+ / �� dwelling,service and/or feeder
`Wi 6 at L• boReconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: SAILA 1.4Araugoz.., 6V Sign or outline lighting 67.84 2
Address: (�[ ) C Signal circuit(s)or limited-energy ❑ See Page 2 2
` lL � \t2A// ei,> S,e.��Z 2, panel,alteration,or extension.
City/State/ZIP � ® q'`7Q�� Each additional inspection over allowable in any of the above
( Additional inspection(1 hr min) 66.25/hr
Phone: ) "/go_4P -a...4_ Fax:( ) Investigation(1 hr min) 90.00/hr
a ' Industrial plant(1 hr min) 78.18/hr
Email: (> /•r r yk_3.Z I i-2. (-Z rn tr q i)o 9,yv Inspections for which no fee is
CCB Lic.: 97 j Electrical Lic.:Z� ( Suprv.Lic.: specifically listed('/hr min) 90.00/hr
/ ( '�` /` ' - p ����� ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:C1'�% lito?%!►' .-.. • Subtotal: lg.(/41
Print name:7cvb ? 1 J/1�-r/ j 1Date:G 2�—"ZO(7 0 Plan Review Required(25%of permit fee): ---
i �V '-I^�( / State surcharge(12%of permit fee): q•(I[
TOTAL PERMIT FEE: g,. _
Authorized signature: b`�j{
This permit application expires if a permit is not obtained within 180
Print name: �� Date:7-/. '7 days after it has been accepted as complete.
--r * Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/1 015 440-4615T(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
Description Qty. I Each I Total I `'
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n 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
with OAR 918-309-0040) 552.26 2
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
EI Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(Y2 hr min)
COlVINtIAL WORK ONLY: ELECTRICAL PERMIT=FEES
Fee for each commercial system: $75.00 Subtotal Enteron Page 1):
y * 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
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11360 SW COTTONWOOD LN, TIGARD, November 17, 2017 at
OR, 97223 9:18:31 AM
Record Type: Record ID:
Residential - Electrical ELC2017-00544
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor