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Permit Support Document (28) IICITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit#: T r G RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 E /18/20-00930 Date Issued: 12/18/2017 Parcel: 25111 CCO2000 Site address: 10335 SW CENTURY OAK DR Jurisdiction: Tigard roject: 335 Century ak Dr. ard-bathroom remodel. Project Desc iipt on: 30ckts.bat room emOodell 1/4/18:REPRINTED to add lowSvollttage ciirSUMMERFIELD Lot: 17 rcuit for floor heat. .111 a Contractor: SQUIRES ELECTRIC . , i;/A4' 657 SE YAMHILL ST 1 Owner: MCKELVEY,ANN PORTLAND, OR 97214 l 10335 SW CENTURY OAK DR TIGARD, OR 97224 PHONE: 503-252-1609 FAX: 503-253-5831 PHONE: Description Specifics• Date Amount Branch Circuits wo/Purchase Service or Feeder 12/18/2017 $71.02 Type of Use: SF 12%State Surcharge-Electrical 12/18/2017 $8 52 Class of Work: ALT Restricted Energy Permit Total Number of Systems: 12%State Surcharge-Electrical 01/04/2018 $75.00 01/04/2018 $9.00 Audio&Stereo: N Security Alarm: N Garage Door Opener: N HVAC: N Vacuum System: N Other: N Other Desc: Total $163.54 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 beys. Ain aTION: with law requires permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 dq you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR • 2-001-0090. You may obtain a copy of the rules or direct questions to o OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: / , ., 4 i � "ariAitPermittee 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' LICENSE NO. Date: 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. Jan 03 2018 12:21AM Squires Electric 5032535831 t+ Electrical Permit A age 1 lication ,���; xiii�'•• I� City of l'igard t - - I rile()ill( I� 13125 S W Hall Blvd-,Tigard, I ,l ()Nr l Phone: 503.7 ll Blvd., 9 OR 97223 F- T �'''''' # . ,111_( �r Tic_;r,It(, Inspection Line: 43.b3Fax:503.598.1960 _ '- Interact: www 503.639.41v .I A N 2 20`,''''es— '� dy Date/By: ._ ❑New construction3 menn n �'�or. . s Gd: SSee P .,,Z-2::.,.... r S °ge, Por ®Addition/alteration/-, - • ❑Demolition telStl tl/ , menta Int ma on - 9 __.�: i...�. 0 Other: P check all that c ,.1 mss"i_";...,. ,.. , ed): . ' =s +�--^e'r x �� aPP1Y�su6mlt2p �' 1 ,;��: 400 f 1-and 2.family dwelling Commercial/industrial p mei I tY- ._.,,, ,. ❑Service or x.where the,0ederie fault amps or more Building ng over three ed es. ❑Multif CiaVindustr.alMs1Q000 current 0 Marinas and boatyards. r exae amllY 0 Accessory building amps a 150 volts or ,1 '.R. ❑Master builder lass to ground,or exceeds 14,000 Q Floating buildings, '��' '"'� � -�-� ❑Other amps for all Job#/. '% other installations. Commercial-use agricultural Job site : "4. ❑Firebuildings, ten => Ci /Stn address.10335 SW Century ' Q En1B1 o pump. yarn• ❑lnuailation of 150 K VA or City/State/ZIP:te/ZIP:Ti and ry Oak Dr. ge eyt st Tigard,OR 0 Addition of now motor loud of mar separately derived Suite/bldg./apt.#: 100HFormore. system. Pro'ectn ❑Sixormoreresident' Q`A„ sec "1-2';"t-3" Cross street/directions J name: � � residential units. occupaaoy eCt10n5 tojobCare facilities. Site: ❑Health-care locations, °Recreational vehicle parks. ❑Supply vs ltage for more than 0 Service or feeder 600 amps or more. 600 volts nominal. Subdivision: r - ` New residential single- } Tax map/parcel#: Lot#: Includes attached or r � Tata) 0 Tax - e. dwelling unit. i�H*,'"` ,ti'"I�`_,�,�.'l�{-��- '�. -�• 1,000 Sc.R.or less pIIIlease 1 x low voltage circuit tom �� � - 'addc.f l„ 1 �il bathroompermit ELC2017 Limped �. i orponion r please add remodel. -00930 for floor heat for a with above ..it residential _n ='-"'�.t4� ;, � Limited � � 75.00 ;.' � energy,multi-family Mlle 2_ �n € - -- - residential with above . ":_... k ft. ■ 75.00 �� Renewahlr Address: '" Services or feeders lnstallapo, � a 200 amps or less a1=on and/or relocation 201 amps to 400 amps 100.70 � 2 Phone: ®� 401 amps to 600 amps 601 am p mill 200.34 - Fa7c:( ) amps to 1,000 amps 1111 installation: installation is beingOver 1'000 amps or volts - 301.09 IB Ownertended installation: sale, n:ThisienTO arprary services or feeders installation, _� t or exchange, made on property that I own which is not relocation alteration,and/or Owner signature S according to ORS 447,449, and 701. 200 amps or less • _ 67p 5 ;r Date: 201 amps to 400 amps Business n599 = .'X ':, ` rt4-U --�1 401 amps r uit amps extension name:Squires Electric,Inc. •,' a'k `Rs`� Branch circuits new alteration or 11111112211111111118 Contact name:Andrew A.Fee for branch circuits with extension er Address:2203 NEM above service or feeder fee, �� L King Blvd. each branch arcus � City/StatetZlP;Portland O B•Fee for braucl,Gireuiu wltitov R 97212 ranch or feeder fee,first 1111111111 Phone:(503 branch ctrcutt � 252-1604 Each add'.branch circuit Email:Andrew Fax. .(503)2 _5831 @SqulresElectric.Co?I Miscellaneous service or feeder �_© r.;. r Each not included -451,7,-",,,.0.,-----.=,-'� -_!rp �q =�:r � manufactured or modular )1,-,...---v''::+.7.:4;. ../.„:„ ;' , ... 1:1...-- ar ^�; ecoon_manufactured or rf �� Business n _ t; mow, feeder name: 1;: Reconnect only l Tom. 67.84 Address: Pump or arigatiig circle Sign or outline lighting `© City/State/ZIP: Signal circuits)or limited-energy �� Phone:( et.alteration or extension ® See Page 2 milfil Each additional ins, coon over allowable In an of the above Additional inspection(1 hr min) - Investigation(I hr min) �_■ 12111 CCB Lia: 135085 Industrial plant(1 hr min � 90.00/ r=� OW 10IA ) ■ Suprv.Electrician signature, marSuprv.Lie.: 4882S snspe tions for which no fee is equired: . IScall fisted %hr min 111111111111313319 tai: hr 0 ifip Print name: Joe Squires ��i 4- r--a, 11111111111 Date: 1/2/18 '- "i ,a: Authorized signature: ❑Plan Review R . Subtotal: 75.00 aired(25%E ,ermit fee); 111111111111111 Print name: State surcharge 12%of Joe Squires permit fee); 9.00 t_lPrint name: Jo Permit Date: 1/2/18 This permit d TOTAL PERMIT FEE 84,00 P'pp_ELR_EItE.doc application expires Nis permit is not obtained Rev 06/172015 days after tt haswithin 180 " Number of in been ucma as co 440-4675T(I 1105/COM/WEB inspections allowed per mptete. panni.. Jan 03 2018 12:21AM Squires Electric 5032535831 page 2 Electrical Permit Application— Page 2—Supplemental Information City of Tigard Limited Energy Permit Fees: ';'-7:;:, .1:,,,--i,, . Renewable Erre Fee for all residential systems combined y 3'Permit Fees: A�M� $7$. e � � Check Type of Work Vox > 0 Involved: Renewable electrical energy �� imrl !0 S kva or less �sysleats; Audio and Stereo Systems* r 5.01 to 15 kva 100.70 1111111111 0 Burglar Alarm 15 01 to 25 kva '� J33..55 6 r© ❑0 of 25 k�34 nomWind•eneradan a stems in excess Garage Door Opener* 25•e1 to 50 Jrya 1111 301.04 so.)!to leo kva ��E1 ?100 kva(fee in accordance - System* with OAR918-309-ee4o111 0 Heating, Ventilation and Air Conditioning ssz.26 11111111Solar generation systems in excess of 25 kva: Vacuum Systems* Each additional kva over 25 1111111Z3 ® Other: Floor heat circuit o >1oU1c"a`nOadd,ttonalcharge 111111111 3 e 0 .111 Each additional i,: ection over allowable is an 3 Each additional inspection is ��ofof t ve: Fee, �� f-.,,��� � r� _ f Inspections hour] 1 hr min1111111 coons for winch hlcb no fee 1s for each commercialS 5 00 ,rte listed ` . III S`, hr �. r4 hr min 9p 00/ system: ��'•" .* (SEE OAR 918-309-0000) ���� ' Subtotal(Enteron Pa raw Check Type Number of inspections allowed per pmt Page l). pe of Work Involved: 0 Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems 0 Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC 0 Instrumentation ❑ Intercom and Paging Systems 0 Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling o Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1.lauildieglPermuseLC PermitApp ELR_EAE.doc Rev 06/17!2615 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 10335 SW CENTURY OAK DR, TIGARD, OR, 97224 Record Type: Record ID: Residential - Electrical ELC2017-00930 Inspection Type: Inspector: 199 Electrical final Jeff Grove Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor