Permit (114) IIICITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit#: ELC2018-00006
T[G ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/03/2018
Parcel: 2S104AA08500
Jurisdiction: Tigard
Site address: 12650 SW KATHERINE ST
Project: DODSON Subdivision: BELLWOOD NO.2 Lot: 100
Project Description: (3)branch circuits for kitchen remodel.
Contractor: EDWARD MILLER&DOMINGO DEOCALES ELECTRII Owner: DODSON, ERIC J &KATIE L
2928 ROBINWOOD DR NE 12650 SW KATHERINE ST
FOREST GROVE, OR 97116 TIGARD, OR 97223
PHONE: 503-502-9667 PHONE:
FAX:
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo/Purchase 01/03/2018 $78.44
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/03/2018 $9.41
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 Aet forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain o les or direct questions to OUNC by calling 503.232.1987 or 1 0. 32.2344 /.,:
C' /
Issued Byx '� 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,,,, ` ;.'t I )R 01:1-1( it I,1-: 4) I.)
City of Tigard �` 1.- ' - Rema
13125 SW Hall Blvd.,Tigard,OR 97223 r \. a T -t DalciB : I J� ,
Phone: 503.7182439 Fax: 503.598.1960 \r` a `_.;-' t r.. Related Permit a:
iipi
inspection Line: 503.639.4175q.y i t -rte >`x Ready Date/By: M See Page 2 for
1u';RD- l 4 .'S-�.
Internet: www ttgard or gov �,' �, q _ Norified/Medm& iiiMil Supplemental Information
TYPE OF WO) ' PLAN REVIEW
❑New construction f"Addition/alteration/replacement Please check all drat apply(submit 2 sets of plans w/itenss checked):
Demolition ❑Other
0 Service or feeder400 amps or more 0 Building over three stories.
0 where the available fault anent ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
,kr1-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: ['Fite pump. ❑illation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
uan
Job#: Job site address: Z.� 5 Lid �� ❑Addition°f new motor load of m -
'��v0 �tyT FfriF/Nle I00HPormore. ❑"A","E","1_2","1_3",
City/State/ZIP: /,, /� (� �a 7j ❑Six or mom residential wets. occupancy.
.7-1 y v F I T/ r ❑Health cure facilities. ❑Recreational vehicle parks.
Suite/bldg apt.#: Project name: J ,ki f ra/a �? Al% ❑Hazardous locations. 0 Supply voltage for more than
❑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
1 •
New residential single-or multi-family dwelling unit
Subdivision: Lot#: Includes attached garage.
1,000 sq.R or less 168.54 4
Tax map/parcel#:
Ea.add'l 500 sq.R or portion 33.92 1
/�
DESCRIPTION OF WORK Limited energy,residential
CAN
L(r Gf43 J ri i 1C)bkt-- 4 � gi GDC414- (with above sq.n.) 75.00 2
1 `_ ( Limited energy,multi-family 75.00 2
/ "t C 1'Li'A- sresidential(with above sq.R.)
PROPS OWNER I ❑ TENANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: ✓ vv i C 'Vc)))5 6 � ( ( / G 200 amps or less 100.70 2
Address: /.2 tf 1v1
3W Y'IH'r �/J J7- 201 amts to 400 amps 133.56 2
A n P �1 401 amps to 600 amps 200.34 2
City/State/ZIP: 6✓/"(L!)c VI— q 7.13- 3 601 amps to 1,000 amps 301.04 2
Phone:( i j ' ti( 'j Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installations 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 signstu
: Date: 401 amps to 599 amps 168.54 2
APPLICANT I - ID CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
// A.Fee for branch circuits with
Business name: above service or feeder fee, 7A2 2
each branch circuit
Contact name: B.Fee for branch circuits without service or feeder fee, r •
Address: branch circuit first I 56.18 D 2
City/State/ZIP: Each add'l branch circuit 3 7.421' 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
y.�,�A� NTaRA OR r./-� Li6C
Pump or irrigation circle 67.84 2
Business name: Cj 4 44 $4,11,t-r. 17 D L t; t Ut L-�, / C, Sign or outline lighting • 67.84 2
Address: ®jJt 7 J/` p�1 �li -- Signal circuit(s)or limited-energy
panel,alteration,or extension 0 See Page 2 2
p e.�0, �d `� (' I Each additional inspection over allowable in any of the above
City/State/ZIP: Fba1 p�/(��JWr lav' "y I w _
Additional inspection(Ihrmin) 66.25/hr
Phone:(. 0/23 -. ("�&2(p/ Fax:(`�)6�'� S3 D . ,�7 09 Investigation(1 hr min) 90.001 hr
Email: (lam mg te( l,F S j t'ot.? a � / . C 3 t Industrial plant(I hr min) 78.18/hr
V Inspections for which no fee is 90.00!hr
CCB Lic.:„.1(214,21 1 Electrical Lic.:C C(OS Suprv.Lic.:,i 29S specifically listed('/z hr min) _
tGC I 1 L� ELECTRICAL PERMIT FEES
Suprv.Electrician sign re,required: � �! ��/ t f Subtotal: iia
Print name: ,.,."�22 p v �,Mr/l� Dat ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 1-it j
Authorized signature: TOTAL PERMIT FEE: '7.is--
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
UBuildingWermits\ELC_PennitApp Erg ERE.doc Rev 06/1712015 440.4615T(11/05/COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12650 SW KATHERINE ST, TIGARD, OR, 97223 March 23, 2018 at 9:22:46 AM
Record Type: Record ID:
Residential - Electrical ELC2018-00006
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor