Permit (49) IIIICITY OF TIGARD ELECTRICAL PERMIT
i COMMUNITY DEVELOPMENT Permit#: ELC2018 00268
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/30/2018
TIGARD 9
Parcel: 1 S134DC08100
Jurisdiction: Tigard
Site address: 11660 SW GALLO AVE
Project: USA SECRETARY OF VETERANS AFFAIR Subdivision: GALLO'S VINEYARD Lot: 12
Project Description: Reconnect only.
Contractor: Owner: USA SECRETARY OF VETERANS AFFAIR
DEPARTMENT OF VETERANS AFFAIRS
LOAN GUARANTY SERVICE
3401 WEST END AVE STE 760W
NASHVILLE, TN 37203
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 04/30/2018 $67.84
Specifics:
1 ea 12%State Surcharge- 04/30/2018 $8.14
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 set forth in OAR
952-001-0010 through OAR 952-001-0090. Yai - .. o '- . . .r direct questions to OUNC by calling 503.232.1987 1.800.332.2344.
Issued By: �G —: °-.---- --rmittee 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 FOR OFFICE USE ONLY
- Ill
City oTigard Received , .,i _ _
II 13125 SW Hall Blvd.,Tigard,OR 97 Date/B : ...
Plan Review
Phone: 503.718.2439 Date/B : Related Permit#:
T I G A K D Email: TigardBuildingPermits@Tigard-or.gov Ready Date/By: IO See Page 2 for
Inspection Line: 503.639.4175 Internat:ppyvlti�r Ty ov Notified/Method: iy Supplemental Information
.w , ,. f"-- a.TY.OP,, tHi rt f�\ VVt �I ,,, PLAN JREVIEN'� '1
❑New construction 0 Addition/alt�r 4WlltARD Please check all that apply(submit 2 sets of plans w/items checked): `
ti f j
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: BUILDING tDl
V where the available fault current
0 Marinas and boatyards.
CATEGORY OF 3 CTION exceeds 10,000 amps at 150 volts orri
,_/ 1' TRz. 0Floating buildings.
21-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder D Other: 0 Fire um
.-- .< �., pump. 0 Installation of 150 KVA or
JOB ySIT IN ORMATION'AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: 16ro t/ // q 0 100H Addition mf oew motor load of system.
`V Cr`'i" O rt-1*�.�- ]OOHP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: trd ❑Six or more residential units. occupancy.
�� et-
2 Z
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: %45 4 S��P� o/i_1 0 Hazardous locations. ❑Supply voltage for more than
"'tY VG/! ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: 460 1) FEE SCHEDULE` -
Description ,.... I Qty. I Each 1 Total 1..:,*
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCIOPTION F.WORK ':' „.
Limited energy,residential 75.00 2
Try C-� ,- �'1 (with above sq.ft.)
' Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
- f, r.;.ROPERTY OWNER .: ;TENANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: Ulfg _ ek2kQ,l ge;ktzt..ts Al2C, 200 amps or less 100.70 2
Address: I) 'Co ; c- J(o `U 201 amps to 400 amps 133.56 2
l t 401 amps to 600 amps 200.34 2
City/State/ZIP: �
<A L- l l9A2-„ q72-2- 601 amps to 1,000 amps 301.04 2
Phone:( ) 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
w
,, _ NT APPLICAw�' . p(.� CONT?iC�' PEPERSON � , A.Branch circuits-new,alteration,or extension,per panel
. Fee for branch circuits with
Business name: ji:erig :X-td-- j„4-CS'i- ktto,ttic./t above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: . service or feeder fee,first
1 �7 5td:
branch circuit 56.18 2
City/State/ZIP: WC,Q Each add'l branch circuit
`U �' �7Z23 7.42 2
Phone:(' ) � `q
1 Miscellaneous(service or feeder not included)
E3 S J Each manufactured or modular 67.84 2
Email: O'n.t.�.d 1`i c•-ct,.lZ a- CU c t.01./4------ dwelling,service and/or feeder
0OR Reconnect only 1 67.84 /7 2
;z 1 N"°�-- , , Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) min hr Investigation(1
g ) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed('A hr min) 90.00/hr
Suprv.Electrician signature,required: Subtotal: 7
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: aviTOTAL PERMIT FEE: c
5= rd
'L_ pp This permit application expires if a permit is not obtained within 180
Print name: TTt �'tta,u,.._ Date: 4.(3vj f 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:
+��, D� SEE SCUEDULE
�.�j,, Jli I, •♦ T. 1. » .xr. Description I QlY 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
n 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)
n H• eating,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
ID V• acuum Systems*
Each additional inspection over allowable in any of the above:
n OthEach additional inspection is 66.25/hr 1
er: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(Vz hr min)
u3 ELECTRIt 'PERMIT FEES
O ERCtAL O 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:
❑ A• udio and Stereo Systems
n B• oiler Controls
n C• lock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
Cl 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:\Buildmg\Permits\ELC PermitAppELR ERE.doc Rev 10/26/2017
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11660 SW GALLO AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Electrical ELC2018-00268
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor