Permit (50) CITY OF TIGARD ELECTRICAL PERMIT
'> COMMUNITY DEVELOPMENT Permit#: ELC2017-00633
-f(GAR 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/28/2017
Parcel: 2S111AD03900
Jurisdiction: Tigard
Site address: 14595 SW 89TH AVE
Project: GOEBEL Subdivision: PINEBROOK TERRACE Lot: 36
Project Description: (3)branch circuits for NC,furnace,and outlet.
Contractor: PORTLAND INDUSTRIAL SERVICES INC Owner: GOEBEL, GREGORY K&ELSA L
7715 NE 21ST AVE 14595 SW 89TH AVE
PORTLAND, OR 97211 TIGARD, OR 97224
PHONE: 503-208-3840 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 08/28/2017 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/28/2017 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon Arrw requires you • follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 9,7.01-0090 You m/.btain a cop of the r les or direct questions to OUNC by calling 503.232.1987 or 1.8.0.332.2344.
Issued By: 'Y'Cw`
,pi
G%Z%iLi Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE ONLI
Cl ofTigard C1W'
' ceived ',- •5g ateB Iii a 13125 SW Hall Blvd.,Tigard,OR 97223 . Plan Review 7�,
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#: C�C/�7-0
Inspection Line: 503.639.4175 „,,, 0, Ready Date/By: Juris ® See Page 2 for
T I G A R D Internet: www.tigard-or.gov f\\1 s0 Z1 Notified/Method: Supplemental Information
.
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❑New construction C: ,ddition/alteration/rapl: -' enPlease check all that apply(submit 2 sets of plans w/items checked)
�$ �,iI� �
0 Service or feeder 400 amps or more 0 Building over three stories
0 Demolition 0 Other: a,. tEF � where the available fault current 0 Marinas and boatyards.
• � a-
,,,„, �. „® s � f exceeds 10,000 amps at 150 volts or 0 Floating buildings.
01-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
41 a u 1V VOII*ibr, :9!' C ”: ^v � � >y= . t r:�, � .. :”, _ : :7: ; 0 Emerenc system. larger separately derived
❑Addition of new
Job#: Job site address: /ys',s 5 i �f A„? .motor load of "0"A",tem.
jJ 100HP or more. "E","1-2","1-3",
City/State/ZIP: -77i4..-4, o/? 9922 y 0 Six or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: h' t -,Vr$ -
Qty
Description i . I Each ITotal
New residential single-or multi-family dwelling unit.
Subdivision: 1 Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'I 500 sq.ft.or portion 33.92 1
am: ,.,i- _4 Nu t, , i- i ' i1 :400,, ,.:.. Limited energy,residential
(.
�r / Q V 1�L (with above sq.ft.) 75.00 2
Cr T� 'T / w/-i7 4.a_ iPe to02.p6 L Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
�l" R1 � �'t �I " k°I .._ _ 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:( ) I 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
Branch circuits—new,alteration,or extension,per panel
- 1,�. ' ..10
b3a .,„ A.Fee for branch circuits with
Business name:Same, qS 4,f(J� above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first
Address:
branch circuit A 56.18 2
City/State/ZIP: Each add'l branch circuit Z. 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular 67.84 2
Email: dwelling,service and/or feeder
Reconnect only 67.84 2
d''-:, . ,_ ,",',1011-*"b > f - i __ Pump or irrigation circle 67.84 2
Business name: R�4tid �hwsSel ic/ ,.... ..,•,(//c" e 44 c Sign or outline lighting 67.84 : 2
Address: 79/5-- /Ve z, so- ,,� ignl circuit(s)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP: /Pe✓ /A^A/ on fvz/f Each additional inspection over allowable in any of the above
i Additional inspection(1 hr min) 66.25/hr
Phone:(5-Q3) .SQ CI 3 015- Fax:( ) Investigation(1 hr min) 90.00/hr
L/ /
\\/\ Email: „jib-r f tArr�G/^C� X70 t4/IM 4f CO rti �o/I �1 Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is
CCB Lic.:ZQO C/9L Electrical Lic.: (1/0/ Suprv.Lic.:3/S3 5 specifically listed('Y2hrmin)
90.00/hr
^ s Bart
.` �•: rte- _
Suprv. Electrician signature,req Subtotal:
Print name:5 frt L frf 0 ore-, C I Date: g/Zg/p7 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: (.. �� TOTAL PERMIT FEE: 79. ✓�
® This permit application expires if a permit is not obtained within 180
Print name: L4 Date: Q.28 ..r days after it has been accepted as complete.
47; V * Number of inspections allowed per permit.
i\Building\Permits\ELCPermitAppELR_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:
Fee for all residential systems combined: $75.00 Description Qty. Each _ Total
y Renewable electrical energy systems:
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:
❑ 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:
❑ Other: Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr 1
Inspections for which no fee is 90.00/hr
se
c c. ly i -,(% iu't)
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
El Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
❑ 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.doe Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14595 SW 89TH AVE, TIGARD, OR, 97224 August 29, 2017 at 10:28:34
AM
Record Type: Record ID:
Residential - Electrical ELC2017-00633
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor