Permit (99) CITY OF TIGARD ELECTRICAL PERMIT
142, '� COMMUNITY DEVELOPMENT Permit#: ELC2018 00339
T I.GA RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/23/2018
Parcel: 1 S 135BD02700
Jurisdiction: Tigard
Site address: 9552 SW ANNA BELLE CT
Project: Ash Creek Village,Lot 13 Subdivision: ASH CREEK VILLAGE Lot: 13
Project Description: (1)branch circuit for A/C installation.
Contractor: ROSS ELECTRIC INC Owner: SAGE BUILT HOMES LLC
2870 SE 75TH AVE#203 1815 NW 169TH PL STE 1040
HILLSBORO, OR 97123 BEAVERTON, OR 97006
PHONE: 503-642-2800 PHONE:
FAX: 503-642-5815
FEES
Quantity Description Date Amount
Specifics: 1 crt Branch Circuits wo/Purchase 05/23/2018 $56.18
Service or Feeder
1 ea 12%State Surcharge- 05/23/2018 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 t• • • - rules adopted by the Oregon Utility Notific-.• C.nt, .? Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may ob-'• opy of - rules or direct questions to OUNC by calling 50 23 •;7 or 1.800.332.2344.
, -7 0 (7r/-- 4
Issued By: . .— : Permittee Signature:
VP
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 503.639.4176 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 FOR OFFICE l Si: 0 1.1
City of Tigard RECEIVE ;�,('eceived
,111 is 13125 SW Hall Blvd.,Tigard,OR 97223 Date/B : �� '
a - Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 .,/Ayal 110 Date/B . '
Inspection Line: 503.639.4175 + eF c u 1[1 -� �` '
T I G A R n p Ready Date/By: 7uris 0.1 See Page 2 for
Notified/Method:
Supplemental www.tigard-or.gov
eSu lC it . : P GA , �r :21 a ::: r
®New construction ❑Addition/alt."1 i s r,=111 • e4,-DIVISION Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
(�
� where the available fault current 0 Marinas and boatyards.
.
u`r '�`� ,r,> r tiV,*.i O 5, , exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® I-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to groans,or exceeds 14,000 ❑commercial-nae agricultural
❑Multi famll y ❑Master builder ❑ amps for all other installations. buildings.
Other: 0 Fire um
rz r�r 'r�, pump. 0 Installation of 150 KVA or
t,,,! 1 i :401 A$)1 t) ; ';1~0S ❑Emergency system. larger separately derived
Job#: Job site address:9552 SW Anna Belle Ct _ ❑Addition of new motor load of system.
100HP or more: : "A","E","1-2","(-3",
City/State/ZIP:Tigard,OR ❑Six or more residental units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Ash Creek ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:
fu
Description I Qty. f Each I Total I ..
New residential single-or multi-family dwelling unit.
Subdivision:Ash Creek Lot#:13 Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
` "' Limited energy,residential
NEW RESIDENTIAL CONSTRUCTION 75.00 2
(with above sq.ft.)
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
�,w Renewable Energy CI See Page 2
a,, a.*�v ''° " ` "" 1* � �' '` Services or feeders installation,alteration,and/or relocation
Name:SAGE BUILT HOMES LLC 200 amps or less 100.70 2
Address:1815 NW 169Th PL.SUITE 1040 201 amps to 400 amps 2
401 amps to 600 amps 200.34 2
City/State/ZIP:BEAVERTON,OR.97006 601 amps to 1,000 amps 301.04 2
Phone:(503)533-5167 Fax:(503)533-5167 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 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 signature: Date: 401 amps to 599 amps 168.54 2
;r. q *s ;'" 1V h $RS N Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:SAGE BUILT HOMES LLC above service or feeder fee,
each branch circuit 7.42 2
Contact name:Ben Cooper B.Fee for branch circuits without
Address:SAME AS ABOVE service or feeder fee,first ) 56.18 .11T 2
branch circuit tsz,
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 971 ) 258-6658 Fax::( ) Each manufactured or modular
Email:BEN@SAGEBUILTHOMESLLC.COM
dwelling,service and/or feeder 67.84 2
econnec on67.84 2
;.MOC1 l'i7;` ,<.. Pump or irrigation
ion circle 67.84 2
Business name: Ross Electric Sign or outline lighting 67.84 2
Address:2870 SE 75th Ave 203 Signal circuit(s)or limited-energy
panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP:Hillsboro Oregon 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( 503)642-2800 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78,18/hr
Inspections for which no fee is
CCB Lic.: 157891 Electrical Lic.: 34-436c Suprv.Lic.: 4232-5 sTectficallX listed(''A hr min) 90.00/hr
K-Q
Suprv.Electrician signature,required: j"j, b ) :'i
od
Print name: Stephen Rosso Subtotal: St,I
Date: 5/23/2018 0 Plan Review Required(25/o of permit fee):
State surcharge(12%of permit fee): es,• ]Z(
Authorized signature: 1.942.02- ��/�Q2 TOTAL PERMIT FEE: ( ..v.(�/ This permit application expires if a permit is not tained within 180
Print name: Ben Cooper Date: 5._'7 2 --le days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC_PelmitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: =r rtt DUL
E
Description I Qty. I Each Total f *�
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Each additional inspection is 66.25/hr 1
Other: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(' hr min)
� L, CT�GAL VOMIT COMMERCIALWORK ONL Subtotal(Enter on Page 1).
Fee for each commercial system: $75.00 + Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ 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
I:\Building\Permits\ELCPermitApp_ELR_ERE.doe Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9552 SW ANNA BELLE CT, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Electrical ELC2018-00339
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Electrical for ac ok.
Violation Summary:
Inspector Contractor