Permit Support Document (5) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT " Permit#: ELC2018-00248
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 / mac" Date Issued: 04/16/2018
B[t�" IO g Parcel: 2S103BA00700
Jurisdiction: Tigard
Site address: 11825 SW WALNUT ST
Project: MW-Gaarde-18081 Subdivision: None Lot: None
Project Description: New sub panel,New craft room addition. 5/2/2018: REPRINT permit to add(6)additional branch circuits.
Contractor: CLACKAMAS ELECTRIC INC. Owner: GAARDE, RICHARD&JUDITH LIVING
PO BOX 51 11825 SW WALNUT ST
BEAVERCREEK, OR 97004 TIGARD, OR 97223
PHONE: 503-969-5684 PHONE:
FAX: 503-632-2421
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 04/16/2018 $100.70
Specifics: amps or less
5 crt Branch Circuits w/Purchase 04/16/2018 $37.10
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 04/16/2018 $16.54
Electrical
Type of Const: 6 crt Branch Circuits w/Purchase 05/02/2018 $44.52
Occupancy Grp: Service or Feeder
0 ea 12%State Surcharge- 05/02/2018 $5.34
Electrical
Total $204.20
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 a A $01-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: % C -f Permittee Signature: Q'V /.,70/62-./641-770"/
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 OFFlcc Il SF Only
qCity of Tigard DateB ennui+l p-- �/`� /j
Recetv)d��/� G�e,RQ"O 11Q�q,
13125 SW Hall Blvd.,Tigard,OR 97223 ._..... ___. .
II
■` Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Inspection Line: 503.639.4175 Date/By: Related Permit#:
TPGrIRp _,-. _.
Internet: www.tigard-orgov
Ready Date/By: 1 Juris: a See Page 2 for
Notified/Method: '. Supplemental Information
"7,77 + Business name:
TYP> i;UF wc;'RK .i � act G.;KGtAr r-1 f:c, �l,ec�-y-_ c
New construction Addition/alteration/replacement L--"" Address:T(2) 1
Demolition Other: City/State/ZIP:.-
CATEGORY OF CONSTRUCTION Phone:( -" )032 ' Fax:( )
1-and 2-family dwelling t----Commercial/industrial Accessory building Email:
Multi-family Master builder Other: V__'C�-C'= C iTAC.KaLf"YICt ScIPI={Y`C,r^tt
W.. ..
-- ___ CCB Lic• 1(�,l q 23 Electrical L�.: 3_�& S
JOB-SITE•INFORIMCATION AN.B: ,OCATION ' ,
. 1 Suprv.Electrician signature,required: $ f -I
Job#: Job site address: ( t
`°` - Print name: 3— 5,4113 L
City/State/ZIP .r'' .01`‘ ' . - .
Suite/bldg./apt.#: Project name: Authorized signature:vv1 _ c - L
Cross street/directions to job site: Print name: L
PLAN REVIEW
Subdivision: Lot#
Please check all that apply(submit/sets of plans w/items checked):
Tax map/parcel#
Service or feeder 400 amps or Building over three stories.
more Marinas and boatyards.
,, - .OIi SCRiPTION OF WORK. , 'i where the available fault current
Floating buildings.
i exceeds 10.000 amps at 150 volts Commercial-use agricultural
1vL:�....> .. ,:..r�t2-.L ✓E i J. ," _ ( l less to ground,or exceeds 14,000 Installation of 150 KVA or
buildings. .
111 ... ........_
,.(-7.:4-�n uE- 1 'CL 1$ 4 amps for all other installations. target separately derived
Fire pump. system.
Emergency system.
PROPERTY OWNERS r TENANT .I r Addition of new motor load of occupancy.
100HP or more. Recreational vehicle parks.
Name: Six or more residential units. Supply voltage for more than
_ _ __._ Health-care facilities. 600 volts nominal.
Address: Hazardous locations.
a Service or feeder 600 amps or
City/State/ZIP more.
Phone:
hone ( ) Fax:( ) FEE.SCHEDULE
Small: { Description Qty. Each . Tool
Owner installation:This installation is being made on property that I own which is j New residential single-or multi-family dwelling unit.
Includes attached garage.
not intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and , _
701. 1,000 sq.ft.or less 168.54 4
Owner signature Date 1 '{
. Ea add'1500 ft or
APPEICA.NT' I __. 3392 .
sq portion
dONTAcT PERSON Limited energy,residential
Business name: (with above sq.ft.)
75.00 i 2
_- _._... ..--- --- -.. Limited energy,multi-family
Contact name: residential(with above sq. 75.00 j 2
ft)
Address: . —_—_---.._ I. ._._.
- -- Renewable Energy See Page 2
City/State/ZIP:
-j Services or feeders installation,alteration,and/or relocation
Phone:( ) 1 Fax: :( ) ,
:�.__.-- -._____-- ---- — ----- 200 amps or less 100.70 1 2
Email:
�. -- — ., _l 201 amps to 400 amps 133.56 ' 2
CONTRAC I'OR --._
- • -- -- 401 amps to 600 amps 200.34 : 2
I:\Building'Permits\ELC_PermitApp ELR ERE.doc Rev 06/17/2015 440-46t5T(I1/05/COM/WEB
601 amps to 1,000 amps 301.04 E 2
Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
relocation
200 amps or less 59.36 1
201 amps to 400 amps 125.08 12
401 amps to 599 amps 168.54 ; 2
Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
above service or feeder fee.
7.42 2
each branch circuit
B.Fee for branch circuits
without service or feeder fee,
56.18 I 2
first branch circuit
Each add'I branch circuit 0 7.42 'qt, •2. 2
Miscellaneous(service or feeder not included)
--
Each
Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 i f 2
Pump or irrigation circle 67.84 } 2
Sign or outline lighting 67.84 2
Signal circuit(s)or limited-
energy panel,alteration,or See Page 2 ! 2
extension f {
Each additional inspection over allowable in any of the
above
Additional inspection(1 hr min) 66.25/hr I
Investigation(1 hr min) 90 00/hr j
Industrial plant(I hr min) 78 18/hr
Inspections for which no fee is I —
specifically listed(V2 hr min) 90 00/hr
ELECTRICAL PERMIT FEES
1
Subtotal t4} �,�
Plan Review Required(25%of permit fee): 1
State surcharge(12%of permit fee): 53
TOTAL PERMIT FEE g.
This permit application expires if a permit is not obtained within 180 days after it has been accepted as
complete.
* Number of inspections allowed per permit.
I:18ui1,16g\Permiis\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11825 SW WALNUT ST, TIGARD, OR, 97223 June 26, 2018 at 8:52:58 AM
Record Type: Record ID:
Residential - Electrical ELC2018-00248
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor