Permit (192) CITY OF TIGARD ELECTRICAL PERMIT
III21 : '.. COMMUNITY DEVELOPMENT Permit#: ELC2017-00542
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/20/2017
TIGARD g Parcel: 2S104CB00400
Jurisdiction: Tigard
Site address: 13421 SW ASCENSION DR
Project: Merckling Subdivision: HILLSHIRE WOODS Lot: 20
Project Description: (2)branch circuits. Run new wire for heated floor.
Contractor: ABS ELECTRIC LLC Owner: MERCKLING JOINT TRUST
752 DIVISION ST 13421 SW ASCENSION DR
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503-888-7676 PHONE:
FAX: 503-257-6168
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 07/20/2017 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 07/20/2017 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 i •r.an - 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. ' TENTION: Oregon -w -qu es you to follow the rules adopted by the Oregon Utility Notification Ce ter. Those ru s are set forth in OAR
952-0J1-0010 through OAR 952-6,41-0090 .0 may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1 87 or 1.800.332. 44.
Is-ued By: 1 r 2,111 ,/ «_Iit._ 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' tam Date: 780 /
i
LICENSE NO. .. 9 b 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 Application rolz oii is i. t SL 0yI.1
�J
Cl O Tigard and �,� /
Datejiew
: Permit#:511 . 13125SWHallBvdTigard,O
C Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:Pa-0a 7+ 1=0,A v,
Inspection Line: 503.639.4175 JUL 2 0 2017 Ready Date/By: Juris: ® See Page 2 for
1 1 C ARU Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE 0'�t ' t,° I�NH�
PLAN REVIEW
❑ orAl , l` �� Please check all that apply submit 2 sets ofplans w/items
New constructionldditi bjl 1 cdtrient pp y( checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
lgt 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: 0 Addition of new motor load of system.
LaZ
I ;5 Li J S(..._1,,y,,,,(3-, off(. 100HP or more. ❑«A» «E» «1 2»«1.3»
City/State/ZIP: 0 1 0 Six or more residential units. occupancy.
t'J f 7�? ._ 0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ' ( V-‘Lt N 0 Hazardous locations. 0 Supply voltage for more than
T ❑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
DESCRIION OF WORK Limited energy,residential
75.00 2
T
,�y�r� r el (with above sq.ft.)
1° ��+v 'S11
� t / Limited energy,multi-family 75.00 2
<rs4 residential(with above sq.ft.)
PROPERTY OWNER 0 TENANT
Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: }-'i t ie-K O G 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
0
APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7'42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 1 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit ' 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: c EC i�rti, ( L. (( Sign or outline lighting 67.84 , 2
Signal circuit(s)or limited-energy
Address: - - ,d t///��1 may, (-)f _ panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: 'cce( (. La `_1 t -1 'I Each additional inspection over allowable in any of the above
( . � Additional inspection(1 hr min) 66.25/hr
Phone: n C 4-49Fax: Investigation 1 hr min 90.00/hr
' Industrial plant(1 hr min) 78.18/hr
Email:
C--)C(>T� r.. Et R( O C6 n Inspections for which no fee is
1 6 CI'8 1specifically listed(A hr min) 90.00/hr
CCB Lic.: Y U Electrical Lic.:�� --��.����Suprv.Lic.: ,)913...6 '
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: -':,4,-/14"- c /\3 Subtotal: (733.6,0
Print name: E G ,-C C L t j Date: it v/L 11 ❑Plan Review Required(25%of permit fee): O'
State surcharge(12%of permit fee): 743
TOTAL PERMIT FEE: 7/.,I.3
Authorized signature:
I f �J This permit application expires if a permit is not obtained within 180
Print name:q�., _ 0('l �, -2.1).v,..4._,..,- 'Date: `3(1 I ,t^-. days after it has been accepted as complete.
j ! * Number of inspections allowed per permit.
I:\Building\Permits\ELCP_yrmitApp_ELR_ERE.doc Rev 06/17/2015 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 *
Fee for all residential systems combined: $75.00 I QRenewable electrical energy systems: Each I Total I
Check Type of Work Involved: 5 kva or less 100.70 2
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:
n Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
n 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
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('A hr min)
COMMERCIAL WORK ONLY : .
ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELCPermitAppELRERE.doc Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13421 SW ASCENSION DR, TIGARD, OR, 97223 October 18, 2017 at
2:10:44 PM
Record Type: Record ID:
Residential - Electrical ELC2017-00542
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor