Permit Support Document (30) CITY OF TIGARD r, ELECTRICAL PERMIT
- COMMUNITY DEVELOPMENT
Permit#: ELC2017-00828
1, Date Issued: 11/06/2017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103BD03700
Jurisdiction: Tigard
Site address: 11905 SW FONNER ST
Project: Pacific Home Remodeling Subdivision: None Lot: None
Project Description: Install sub panel for future workshop and extend existing circuits for addition. 11/16/2017: REPRINT permit to
increase number of branch circuits to(6).
Contractor: MISTER SPARKY OF BEAVERTON Owner: HUBER FAMILY TRUST
6775 SW 111TH AVE STE 20 11905 SW FONNER ST
BEAVERTON, OR 97008 TIGARD, OR 97219
PHONE: 503-643-3500 PHONE:
FAX: 503-861-2157
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 11/06/2017 $100.70
Specifics: amps or less
3 crt Branch Circuits w/Purchase 11/06/2017 $22.26
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 11/06/2017 $14.76
Electrical
Type of Const: 3 crt Branch Circuits w/Purchase 11/16/2017 $22.26
Occupancy Grp: Service or Feeder
0 ea 12%State Surcharge- 11/16/2017 $2.67
Electrical
Total $162.65
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 throug ••' 952-001-009'. 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 „TIC'' .. Permittee Signature: Cl/ll ��/6- 770 A/
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 603.639.4175 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.
RECEIVED
Electrical Permit Application FOR OFFICE USEONLY
•
City o TigardReceived /7'Qt����,
i annrt
1101 -yiJ g NOVNQV 15 1.017 _ t ��,_/„ ___ _ �'
-x 13125 SW Hall Blvd I Igard,O13 97223 ,
Phone: 5(13.718 2439 Fax: 503 598TIGARD uis Related Permit k:
Inspection Line: 503.639 4175 + heady Date Ov: tsars '^ 0 Ser ly.1t_r 2 fug
TIGARDa DING
Notifkd titelhod 'Supplemental elemental lnlarn.rnon '
Internet: Hwvv.ugard or�Ov BUT!DI�11DIVISION- --' -•-__.._ .__.._.._. + f l
TYPE OF WORK I { PLAN REVIEW
D New construction Addition/alteration/replacement please check all that apply(submit 2 sets of plans whtenns checked):
' ❑Service or feeder 400 amps or more 0 Building Os Ci three shin.,
❑ Demolition ❑Other: ' 1 where the available fault current 0 Marinas and boatyards
f CATE(.ORN': OF CONSTRUCTIONexceeds 10,000 amps at 150 volts or 0 Floating buildings
•_ `-_- 3 less to ground,drescccdc 14,000 -0 Commeicial•use air, sit;gal
I-arid 2-family.dwelling ❑C:ommercial/industrial ❑ accessory building 1
amps for all other installations buildings
❑ Multi-family 0 Master builder ❑Other: 0 Fire pump 0 hsrtuauom of 150 K VA or
1 JOB SITE INFORMATION AND LOCATION 1 IDEmergency system larger separately deuced
i 0 Addition of new motor load of system
Job 4: lob site address: , eat 3 Caw I,,,,� r I IooHPormore ❑ + I:: ""t '" l '"'
-" ❑Six or stoic residentialunits occupancy
City/Stare/ZIP: `•`J,�y G N. 611 OA•CI' ❑ Recreational%chicle parks
._-,". --__�.. Health-care facilities
Suite/bldg./apt.1<: Project name: (�( . CE"IvMQ t2.11&.Gc• ❑Hazardous locations. ❑Supply voltage for more than
_ .: ' ❑Service of feeder 600 amps or more 600 volts nominal
Cross street/directions to job site: 1 ," _
FEE SCHEDULE. .
_
.._.:_._. .a_:
[trot ripnan4ant, ( Fad, f,lnl •
t
-.__. _ •.._. ..._.._�.,...-___. .__..,_ New residential single-or multi-family dwelling unit.
Subdivision: i Lot 4: i Includes attached garage. __
1 000 sq ft or less i 168 54 i 1
I'ax map/parcel# I - —t- ..,.
l I a add 1500 sq ft or portion I 33 92 1_ I I
DESCRIPTION OF WORK I
_ ) _.__. ;.•� �limited energy,residential
CFA -
75 00
E S d_,...� t � L Le—lis L t" C`� '''r--.-----tdlr ne ge ti Il• ti 1 j
tel
_ I sorted energy,multi family 75 OU
�� � �.s »C j t-r(�� residential(with about fl) {
❑ PROPER-1'Y OWNER ❑ TENANT Renewable Energy - ._p Sec[age Zws ..
•
..,--_ . _.- .._._ . .,,_; Services or feeders installation,alteration,and/or relocation !
Name: t 200 amps or less i 100 70
201 amps to 4tH)amps 133 56
Addle , L
. . 401 amps to 600 amps 200 1 1.
Ca
its/State/ZIP: i- _.-._.._
1 601 amps to 1000 amps j 301 04
Phone:( ) ` Fax ( ) Over 1.000 amps or volts k I 552,26 1 2
4
.._ ______-__
- --___._.
._ __._, Temporary services or feeders installation,alteration,and/or
Email: t,
relocation ;•
Owner installation:'This installation is being made on property thin I cm orhich is not 200ampsorless f 5936 I
l
intended for sale, lease, rent or exchange.according to ORS 447.449.670.and 701. ` 201 amps to 400 amps 125 08 { 3
O\c ger signature Date: H401 amps to 5)9 amps Fj 168 541 __._ [_
❑ APPLICANT' C0N'I'AC7 PF R'SON Branch circuits new,alteration or extension per panel
A Fee lot branch circuits I I
Business• name: shove service or Feeder lee, t 4' „
each branch circuit
Contact name: .J _.-• i
B Fee for branch circuits without ' i
Address: service or Feeder fee.first 56 18 f
.._:.,__......._._.� branch circuit
Cit)/State/ZIP: Each add'I branch circuit } L 7 42 i —
,_,__ _w.." ._. not
---------- -- Miscellaneous rsccllancous(service or feeder nincluded)
Phonic: )
Each marndaetured or modular 1
_..,..,. dwelling service and/or feeder 67 84
Email _
6784�_._ Reconnect oly
CON' RAC 1OR Pump or irrigation 678!
;
.
_. circle
n ..k„.',", . ,tt , "1aJLASign or outline lighten i 67 8 t s': ° _ _
Signal circwt(s)or limned-eneres I
Address: 3 -�i ❑ See Page 2 ? {
(.,..., __ Y �' ' h�nel N alteration,or extension I
Cit'-State//II' t _ .�/ if 4 Each additional inspection over tlluwabte in any of the above
_...._. Additional inspection(I66 25/hr
._..,_. hr
l
Phone,( i 4 t2 R -_.
$03) ( C i Fax;( ) Investigation(I hr min) 90001 hr '
Email: 7h 1 1 Industrial plant(l hr min) 78 18/hr
---t it l'Yyc `'264-)'k.<,•1 C r 1 Inspections for which no fee is , �
GCB I l n6 G ' Electrical Lie.:(.../.....1C+ Suprv. I.ic : i/4, S spccthcalls listed(r hr min) t 9 UU/hr --
_._ 1. 1,...__ EL I C'I'RICAL PERMIT FEES
Suprv. Electrician signature required: /' ri .0 J 1 - Subtotal: + f� i
Print t1+rat 0 Plan Review Required(25%oY permit tee
, 7 1 j State surcharge(12%of permit fee) 1ur t�p?7.7✓`
TOTAL PERMITFEE, I, /
Authorized signature: 1, i
_. "`" - , Chis permit application expires if a permit is not obtained eithin 180
Print name i s,., ' ,� h))tc f I i'7 days after it has been accepted as complete.
-_,- t___..
- .•..r._ _... _..... ..-.--. ...._.-_ - Number of Inspections allowed per permit
i trend,tie Penh a'ELCV(fp Ri R_SRI=doe Rev 55-Itt) 5 4,40 4515 rt l l 05 Coil/WLR
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11905 SW FONNER ST, TIGARD, OR, 97223 May 9, 2018 at 2:04:06 PM
Record Type: Record ID:
Residential - Electrical ELC2017-00828
Inspection Type: Inspector:
199 Electrical final David Young
Result:
FA I L
Comments:
Re schedule electrical final when owner permitted electrical in shop is complete.
Electrical in house addition ok.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11905 SW FONNER ST, TIGARD, OR, 97223 July 11 , 2018 at 8:01 :14 AM
Record Type: Record ID:
Residential - Electrical ELC2017-00828
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Previous corrections completed.
Violation Summary:
Inspector Contractor