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Permit (93) CITY OF TIGARD ELECTRICAL PERMIT 111.. COMMUNITY DEVELOPMENT Permit#: ELC2017-00526 rt GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/24/2017 Parcel: 1 S 134CA03600 Jurisdiction: Tigard Site address: 11800 SW NORTH DAKOTA ST Project: Sell Subdivision: BURLWOOD NO.2 Lot: 9 Project Description: (2)circuit for NC. Contractor: NORMANDIN ELECTRIC Owner: DIANA SELL 51086 NW CLAPSHAW HILL RD 11800 SW NORTH DAKOTA ST FOREST GROVE, OR 97116 TIGARD, OR 97223 PHONE: 503-357-5380 PHONE: 503-330-2772 FAX: -4 503 357 878 FEES Quantity Description Date Amount 2 crt Branch Circuits wo/Purchase 07/18/2017 $63.60 Specifics: Service or Feeder 1 ea 12%State Surcharge- 07/24/2017 $7.63 Type of Use: SF Electrical Class of Work: ADD 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 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OA ri•52-001-00 . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. / • Issued By: / i 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 Applkcatio City of Tigard `.r .1 A/ g •, l'O ll (I I 1 It. I 1,4 i)�:I.1 11413125 SW Hall Blvd.,Tigard,OR 97223 Br 7//7`/) Permit= fAAap12-(05-X Phone: 503.71&.2439 Fax: 503.598 1960 Plan Review u L 13 2017 : Related Permit 4. a 6 r 1,...`“:„D Inspection Line: 503.639_4175 D ef3y: : �S�e 2 for Internet: www.tigard-or.gov ITy OF TIGARD N°66e�: ///l/� I or mation TYPE OF fI.! i PLAN i!eiDIVISIONeconstruction 0 Addition/. , : . Please k all that apply(submit wrmemS checked). ❑Demolition 0 Other: 0 Service or feeder 400 amps or more Cf Building over three stories. were the available fault current. ©Ivlarinas and boatyards. _./ CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or Q Floating buildings. 34 I-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 DCommercial-use agricultural Q Multi-family 0 Master builder ❑Other: amps for all other installations. buildings. CI Fire lam. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system- �f �j ,�/ �] lazger separ�ely derived //fa ✓to Nl/[m D, dA 0 Addition of new motor fond of system. Job#: Job site address: 10011?or more. II`A", ,"1-2","1-3", City/Stale/ZIP: / / !�f� II O Six or more residential units. `. . / Health-care faciliaies. ©Recreational le parks. Suite/bldg./apt.#: 8 1 Project name: El Hazardous locations. 0 Supply voltage for more than ©Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: tat,SCirULE Description I Qty. I fact I Total I = New residential single-or multi-family dwelling unit Snhrlivi5[t)n: 1 Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea add'I 500tt or DESCRIPTION OF WORKy, potion 33.92 I Limited energy,residential 75.00 2 It- giv1.56 (with above sq.8..) .� Limited energy,multi-family , residential(with above sq.ft.) 95.00 2 0 PROPERTY OWNER I 0 TENAI+ff Renewable Energv p See Page 2 ^ Cl,')� Sr� Services or feeders iestallatiau(';alteration,andtor 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:(47/230- 2.7 7Z Fax:( ) Over 1,000 amps or volts I 552.26 2 Email: 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 less59.36 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 El,APPLICANT CONTACT P Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or fzeder fee. each branch circuit 7.42 2 Contact name: B.Fee for branch circuits without r Address: service or feeder fee,first r 56.18 5"L•/12 branch circuit City/State/ZIP: Each add'I branch circuit I 7.42 I 7.1-22 Phone: Miscellaneous(service or feeder not included) ) Fax::( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 _ COC' Pump or irrigation circle/V 2 Business name Gb Jt) U Sign or outline lighting 67.84 2 Signal circuit(S)or tanited-energv 0set page 2 2 Address: 0-70 Or // )9 / barrel,alteration,or extension. i Each additional inspection over allowable in any of the above City/State/ZIP: s 0 Cd �j T Additional inspection(1 hr min) 66.25/hr Phone 3./7. "-iv l x:(47.0‘71/457-4O7r investigation(t hr min) 90.00/hr Email: /?1'Yi 1 � 6.Ya..o l i t: i plant i r mo) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lie.: 9go Electrical Lie.Wit-z5-e Suprv.Lie.: 3specifically Vt. sEiT CAL FEES Suprv.Electrician signature,required: Subtotal: /� Print name A/005/ � Date: 7 0 Plan Review Required(25%ofpermit fee): /�/ �.//y/��� 7 c t mo/ State surcharge tilo/0 tld,,(permit feel: j�j� C i Authorized signature: TOTAL PERMIT FEE: - 1.23 This permit application expires'Ha permit is not obtained within 180 Print name: Date: days after it bas been neer-pied as complete. * Number of inspections allowed per permit, 430-4bt51Y1IJO51CL9tvfJWE Z:\Lkuildb*Perr t$ LC PanitApp Elft ERE.doc Rev 06/17/2015 F, City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11800 SW NORTH DAKOTA ST, TIGARD, OR, 97223 Record Type: Record ID: Residential - Electrical ELC2017-00526 Inspection Type: Inspector: 199 Electrical final Jeff Grove Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor