Permit (34) CITY OF TIGARD ELECTRICAL PERMIT
11 COMMUNITY DEVELOPMENT Permit#: ELC2018-00276
TtCiA. D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/01/2018
Parcel: 2S110DD01100
Jurisdiction: Tigard
Site address: 15940 SW GREENS WAY
Project: GORDON Subdivision: SUMMERFIELD Lot: 89
Project Description: Panel replacement.
Contractor: CONDUIT ELECTRIC Owner: GORDON, ELIZABETH B
19461 SW 89TH AVE 15940 SW GREENS WAY
TUALATIN, OR 97062 TIGARD, OR 97224
PHONE: 503-692-1428 PHONE:
FAX: 503-692-3652
FEES
Quantity Description Date Amount
Specifics: 1 ea Services or Feeders-200 05/01/2018 $100.70
amps or less
1 ea 12%State Surcharge- 05/01/2018 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 ru-- are set f in OAR
952-001-0010 through OAR 952-001-0090. a direct questions to OUNC by callin• I .23 987,or 1.800.332,i`4 ^�
tr/
Issued By: ,,-�.�•a✓. Rormittee 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 E; � `
t�EN FOR oFF10E lash.O\1.1
City of Tigard Received
13125 SW Hall Blvd.,Tigard,OR 97223 �A `Z�1 Plan R
IN 0 Phone: 503.718.2439 l' '' Plan Review '
t-li
, 1,Date/B : Related Permit#:
TIGARDEmail: TigardBuildingPermits@Tigard-or.SS��,,v �1�1ct`ady Date/By: kris:
Inspection Line: 503.639.4175 Internet:ly®i t M ttI.NB Supplemental See Page 2Inr
tified/Method: Information
TYPE OF WOIU% PLAN REVIEW
❑New construction 0 Addition/alteration/replacemen Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition Other: I ❑Service or feeder 400 amps or more 0 Building over three stories.
"� n"��l where the available fault current
CATEGORY OF CONSTRUCTION 0 Marinasand boatyards.
exceeds 10,000 amps at 150 volts or ❑Floatingng buildings.
and 2-family dwelling 0 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:
0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: I Job site address: p
0 Addition of new motor load of system.
/�y f St ,/ �1 (i�`�¢— 100HPormore. ❑••A„ "E","1-2> "1-3",
City/State/ZIP: `� J _ —� /�, ry^�7 ,T2 7 ❑Six or more residential units. occupancy.
/ '✓(✓�1 (��` c� L7 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I
TV'
name: ,. f__ 0 Hazardous locations. 0 Supply voltage for more than
Cross street/directions to job site: 9e Et _U',`� �/` /� ❑Service or feeder 600 amps or more. 600 volts nominal.
U {-4-di Dr r FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: cl c 0,1 hv...e. - i_ftC' .t. 4` I Lot#: Includes attached garage.
Tax map/parcel#: �/( 1,000 sq.ft.or less 168.54 4
DESCRIPTION OF WORK Ea.addl 00 sq.ft.or portion 33.92 1
Limited energy,residential
/G CelX.�fw, - (with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
IRUPERTY OWNER I TEN Renewable Energy 0 See Page 2
Name: 6 it' /
t �� � /� Services or feeders installation,alteration,and/or relocation
( 200 amps or less / 100.70 kr,"7 2
Address: / ,S'• 9 y0 ski f cis 201 amps to 400 amps 133.56 2
City/State/ZIP: /, C� ) � 401 amps to 600 amps 200.34 2
wT'Ul /
0� r�L 601 amps to 1,000 amps 301.04 2
Phone:5/3) J j r°—g/ 7 Over 1,000 amps or volts 552.26 2
Email: / J J Temporary services or feeders installation,alteration,and/or
Owner installation:This installation is beingmade on propertyrelocation0amps
or 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
APPLICANT I ONTACT PERSON Branch circuits-new,alteration,or extension, .er panel 2
Business name: I /�� ( A.Fee for branch circuits with
1 f (/E! Si . ,ac ,�h IL( above service or feeder fee, 7 42
Contact name: � / each branch circuit 2
�f B.Fee for branch circuits without
Address: f S� ('� service or feeder fee,first
L 5k,
J ' branch circuit 56.18 2
City/State/ZIP: �� / �/ "��� Each add'l branch circuit 7.42 2
Phone:(S j) %� — ��f �/ o� Miscellaneous(service or feeder not included)
/ Each manufactured or modular
Email: / ') { ®S ' / � f-/t j'�_ dwelling,service and/or feeder 67.84 2
[/' L t� W✓' Reconnect only 67.84 2
CONtIkACTOR
�+ Pump or irrigation circle 67.84 2
Business name: ��l`1! c tJ . CT/Lec Ir i< Sign or outline lighting 67.84 2
Address: / y� �J �f ._p Signal circuit(s)or limited-energy
/ r l! panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: �U �` �rj / Each additional inspection over allowable in any of the above
�� - / (� Additional gati inspection(1eol ) hr min) 66.25/hr
Phone:(�j�) ((A
Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: l Electrical Lic. G/y Suprv. �-^ 90.00/hr
41 L ��j"7 Us-c, p Lic.: �50/ J specifically listed C=hr min)
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES
QG2'v,K f�L^ Subtotal: leo 70
Print name: GtG . v/- I Date:'/ 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): / 0 d
Authorized signature: TOTAL PERMIT FEE i8
This permit application expires if a permit is not tain�d within 180
Print name: I Date: I
days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 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 iQ to \L1: EEE SCHE)ULE
Description I
Qty. I Each I Total I
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
❑ 15.01 to 25 kva 200.34 2
Audio and Stereo Systems*
Wind generation systems in excess of 25 kva:
n Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
F-7 Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
n Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
>100 kva-no additional charge 0.0 3
❑ Vacuum Systems*
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/hr min)
EL`ECCAL=PERMIT SEES
CO IAI'WOK Ql1TI�Y. a 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
Fl Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ N• urse Calls
El O• utdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15940 SW GREENS WAY, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Electrical ELC2018-00276
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor