Permit (105) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT
Permit*: ELC2017-00815
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/01/2017
Parcel: 2S 102AB00914
Jurisdiction: Tigard
Site address: 12105 SW 92ND AVE
Project: Hamnes Subdivision: KIMBERLY ADDITION Lot: 14
Project Description: Replace(1) 100 amp panel
Contractor: PATTERSON ELECTRIC LLC Owner: HAMNES, ROBERT J MARILEE
1834 NE ESTATE DR 12105 SW 92ND AVE
HILLSBORO, OR 97124 TIGARD, OR 97223
PHONE: 503-703-1241 PHONE:
FAX:
FEES
Quantity Description Date Amount
Specifics: 1 ea Services or Feeders-200 11/01/2017 $100.70
amps or less
1 ea 12%State Surcharge- 11/01/2017 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 O 95 -104-0090. ou may obtain a copy of the rules or direct questions to OUNC by callin•503.232.1987 or 1.800. 2.2344.
Issued By: v
G Permittee Signature: \r-L �j
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 Q a -
t. ,r �v.�
City of Tigard eceived f
71 13125 SW Hall Blvd.,Tigard,OR 97223 DateBy: /1 `� Permit No C ` 7 Ql/,/�
Phone: 503.718.2439 Fax: 503.598.1960 lt�0' 1 7 Q 1 f PlanReview C/
Date/By: Other Permit:
TIG �R l� Inspection Line: 503.639.4175
Internet: www.ti ard-or. ov ., Date Ready/ed/Met y: Juris: S See Page 2 for
g g Lit I T (. r E(7 titt"i;)Notified/Method:
�f�L�II'�� DIVISION I Supplemental Information
TYPE OF Wt RK !t V PLAN REVIEW
9 New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
0 Demolition
0 Service or feeder 400 amps or more El Building over three stories.
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.
ice! 1-arid 2-famllless to ground,or exceeds 14,000 0 Commercial-use agricultural
y dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family 9 Master builder
0 Other: 0 Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
0 Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: I Job site address: 12 j(:)5 3,Y X N n 100HP or more. occupancy.
4� Ave--, 0 Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: �I ct r C` 0/ 7�� ❑Health-care facilities. 0 Supply voltage for more than
/ ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: I Project name: F ct r,;j :,,1 ,e 5 0 Service or feeder 600 amps or more.
t �r y
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Fee. I Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq.ft.or less 168.54 4
Tax map/parcel no.: Ea.add'l 500 sq.ft.or portion 33.92 1
Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
` Limited energy,multi-family
R., _p _c,.c . Lc.; 1,C 0 A , ct. o. 'c...L (,
t ,q residential(with above sq.ft.) 75.00 2
4 j� \ Services or feeders installation,alteration,and/or relocation
\.Q- \ 03 1\ t \C�l 1 1, \,A)r t CA. � f�" \, ,(_' 200 amps or less 100.70 i 3O ,7tZ,,,2
❑ PROPERTY OWNER ( 0 TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address:
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
relocation
Phone:( ) I Fax:( ) 200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Branch circuits—new,alteration,or extension,per panel
Date: A.Fee for branch circuits with
0 APPLICANT I X CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B.Fee for branch circuits without
( service or feeder fee,first
Contact name: ' !c,Q 117
G, . CSC branch circuit 56.18 2
Address: „\ Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Ctty/State/ZIP: Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Phone:(5 03) 703 _ 1. t„1l 1 I Fax: :( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Business name: Pc.. .
rS Le (A, , L-1 C._ panel,alteration,or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: It 39 N (,' Additional inspection(1 hr min
1,::: 1 ,, [ , P ) 66.25/hr
City/State/ZIP: (4 LL' ` Investigation(1 hr min) 66.25/hr
/ 7 1 t Industrial plant(1 hr min) 78.18/hr
Phone: L' Fax:
(w3) 703 — ( 2 Lr I ( ) Inspections for which no fee is
.( t — specifically listed(%2 hr min)
CCB Lic.: 90.00/hr
Electrical Lic.: 0-7 70I Suprv.Lic.: /76 ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: '�� - —{ \� Subtotal: OO ,7 ,
v"tiLv'` �f / si\. Plan review(25%of permit fee):
Print name: d
o`�e ti � E%�'�°"��.�o tA f / i',.2.I Date: � � _ � 7 State surcharge(12%ofpermit fee): t O
Authorized signature: TOTAL PERMIT FEE: /,oz , 7J
This permit application expires if a permit is not obtained within 180
Print name: I Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC-PermitApp.doc 07/01/10 440-4615T(]1/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2- Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
O Heating,Ventilation and Air Conditioning System*
O Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
O Audio and Stereo Systems
O Boiler Controls
❑ Clock Systems
O Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
O Instrumentation
❑ Intercom and Paging Systems
O Landscape Irrigation Control*
❑ Medical
O Nurse Calls
❑ Outdoor Landscape Lighting*
O Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\Building\Permits\ELC-PermitAPP.doc 07/01/10
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12105 SW 92ND AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Electrical ELC2017-00815
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor