Permit (159) oh , CITY OF TIGARD ELECTRICAL PERMIT
111 .' COMMUNITY DEVELOPMENT Permit#: ELC2018 00059
T t CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/31/2018
Parcel: 2S 109AC06300
Jurisdiction: Tigard
Site address: 13319 SW MADDIE LN
Project: Madeline Heights,Lot 1 Subdivision: MADELINE HEIGHTS Lot: 1
Project Description: (6)branch circuits and(1)data telecommunications system.
Contractor: THREE PHASE ELECTRIC Owner: LENNAR NW INC
11490 SE JENNIFER ST 11807 NE 99TH ST#1170
CLACKAMAS, OR 97015 VANCOUVER,WA 98682
PHONE: 503-760-8522 PHONE: 360-258-7900
FAX: 503-762-1823
FEES
Quantity Description Date Amount
Specifics: 6 crt Branch Circuits wo/Purchase 01/25/2018 $93.28
Service or Feeder
1 ea Signal circuit or Limited 01/25/2018 $75.00
Type of Use: COM Energy Panel
Class of Work: ALT 1 ea 12%State Surcharge- 01/25/2018 $20.19
Type of Const: Electrical
Occupancy Grp:
Total $188.47
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 • - 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 ' uspended for more the 180
days. ATTENTION: Oregon law requires you to follow the -- adopted by the Oregon Utility Notificati.,. C—" T•• les are set forth in OAR
952-001-0010 through 0 R 952-001-0090. Y in a opy of the rule-or direct questions to OUNC by calling 503.23 v.•87 or .801 :44.
Issued By: cam ,7 n 1
z� .� -� Permittee Signa urea ` �� .
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.
4
Electrical Permit Application` t v ' ;
FOR OFFICE USE ONE
City of Tigard a Received
int • 13125 IIIMIIIMIMINen
SW Hall Blvd.,Tigard,OR 97223 '�"'',° 9 r� 10�i U DafdB , ff/l�fyy��
3 Phone: 503.718.2439 Fax: 503 598 1960
T I G A R D Inspection Line: 503.639.4175 (r l+ .. 1
Internet: Line:www.tigard-or.gov !11 Ready Date/By: BI See Page 2 for
sN, NotifialMedral: II
arty Supplemental Information
TYPE OF WORK
6.44 New constructionPLAN REVIEW
0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/nems checked):
0 Demolition 0 Other. ❑Serviceamps or more or feeder 400
ElBuilding over three stories.
CATEGORY OF CONSTRUCTION where the available fault current 0 Marinas and boatyards.
exceeds 10,000 amps at 150 votes or ❑Floating buildings.
Commercial/industrial ❑Accessory buildingless to ground,arexceeds 14,000
Multi-family ❑Comrnercral-use agricultural
Master builderamps for all other installations. buildings.
0 Other:
0 Fire pump.
JOB SITE INFORMATION AND LOCATION ❑lrrgerstpn tel5dKVAor
❑Emergency system larger separately derived
Job#: l Job site address: l G !,, ❑Addition of new motor load of system.
3! i :J Cnj /`�1l 1/L2.ti; I OOH:or more.
City/State/ZIP: Tigard, OR 97223 " ❑ A"."E, i-z', t-3",
❑Six or more residential units. occupancy.
Suite/bldg./apt.#: M� � ❑Health-care facilities. ❑Recreational vehicle parks.
Project name: It 1,,,e, j *` ❑Hazardous locations. 0 Supply voltage for more than
Cross street/directions to job site: 9 ❑Service or fccdcr 600 amps or more. 600 volts nominal.
FEE SCHIEDULE
Description I Otc. I Each I Total ] •
..
Subdivision: New residential single-or multi-family dwelling unit.
Madeline Heights I Lot#: l Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less
168.54 4
DESCRIPTION OF WORK Ea 500 sq.ft.or portion 33.92 1
NSFR Limitedited enenergy,residential
(with above sq.fl.) 75.00 2
(.6elf 612v4..../A Limited energy,multi-family
(.....,:le-c44,;13 „....„,,t L1, �:lati,- ; LJ residential(with above sq.ft.) 75.E 2
.PROPERTY OWNER I 0 TENANT wlrgy
Name: Lerman NW Inc. ` ServiRenecesabore
feeders installation,alteration,and/or2 relocation
Address: 11807 NE 99th St.#1170 201 20amps orkss 12
amps to 400 amps 1333370.56 2
2
City/State/ZIP: Vancouver, WA 98682 401 amps to 600 amps 200.34
Phone:(360 )258-7900 Fax: 601 amps to 1.000 amps 301.04 2
(360 )258-7901 Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 59.36 1
201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps
168.54 2
EX APPLICANT I VCONTACr PERSON Branch circuits—new,alteration,or extension,per panel
Business name: Same as above A.Fee for branch circuits t fee,
above service or feeder fee,
Contact name: JUTS Call each branch circuit 7.42 2
B.Fee for branch circuits withow
Address: service or feeder fee,first
branch circuit 56.18 90.17 2
City/State/ZIP: Each add'I branch circuit
Phone 5- 7.42 5"4.,It) 2
( ) J Fax::( ) Miscellaneous(service or feeder not included)
Each manufactured or modular
Email: juJsII@lennar.t;om dwelling,service and/or feeder 67.84 2
CONTRACTOR Reconnect only 67.84 2
Business name: Pump or irrigation circle 67.84 2
Lantil LLC dba Three Phase Electric Sign or outline lighting
Address: 67.84 2
11490 SE Jennifer St. Sigma!circuit(s)or limited-energy
City/State/ZIP: panel,alteration,or extension. ® See Page 2 p� 2
Clackamas, OR 97015 Each additional inspection over allowable in any of the above
Phone:( 908-8058 1 Fax: Additional inspection(I hr min) 66.25/hr
I (503 )726-1823 Investigation(I hr min) 90.00/hr
Industrial plant(I hr min) 78.181 hr
Email: Bane@threephaseelectric.com
CCB Lie.: 162368 Inspections for which no fee is
Electrical Lic.: 3-332C I Suprv,Lic.: 3398S specifically listed('/hr min) 90.00/hr
Suprv.Electrician signature,required: ,drte..,. ,./ r ELECTRICAL PERMIT PEES
Print name: Dennis Welch Subtotal: lr, `.;fig'
I Date: ElPlanfee):
Plan Review Required(25%of r'O
t State surcharge(12%of permit fee): t q
Authorized signature: 44 ,"i _ .
- TOTAL PERMIT FEE: !o D ,yl 7
Print name: Robert Lane I This permit application expires if a permit is not obtained within 180
f Date: days after it has been accepted as complete.
t:'Buidir�lPermitstELC_PermitApp_ELR_L•RE.doc Rev 06,17,2015 ` Number of inspections allowed per p
440-16151(11,05±COMAVEB P permit.
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 Description I Qt.. I Eac6 I Total I •
Renewable electrical energysystems:
Check Type of Work Involved: 5 kva or less 100.70 2
115.01 to 15 kva 133.56 2
Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
arage l oor Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance
He• g, •t atio :nd Air Con•itio'ing Oji with OAR 918-309-0040) 552.26 2
System* ( Solar generation systems in excess of 25 kva:
i J c � Each additional kva over 25 7.42 3
El Vacuum Systems* 1 r T >lookva-noadditionalcharge 0.0 ( 3
v ' Each additional inspection over allowable in any of the above:
❑ Other: L I 8;Y.
71 - Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr
Inspections for which no fee is
specifically listed(V2 hr min) 90.001 hr
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enteron Page 1):
(SEE OAR 918-309-0000) • Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
121 Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:13wldiag Permits ELC ernutApp_ELR_ERE d°c Rn'06.17(2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13319 SW MADDIE LN, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Electrical ELC2018-00059
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor