Permit (92) CITY OF TIGARD ELECTRICAL PERMIT
11 11 COMMUNITY DEVELOPMENT Permit#: ELC2018-00526
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/09/2018
T I[ r4 K Cr g Parcel: 2S103DC00820
Jurisdiction: Tigard
Site address: 11270 SW FAIRHAVEN CT
Project: Grant Subdivision: VIRGINIA ACRES NO.2 Lot: 13
Project Description: Adding(1)200 amp service and(10)branch circuits.
Contractor: SHOCKER ELECTRIC LLC Owner: GRANT, JOHN III&KRISTEN
2834 CHAMPIONSHIP DR 11270 SW FAIRHAVEN ST
WOODBURN, OR 97071 TIGARD, OR 97223
PHONE: 503-758-8088 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 08/09/2018 $100.70
Specifics: amps or less
10 crt Branch Circuits w/Purchase 08/09/2018 $74.20
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 08/09/2018 $20.99
'Electrical
Type of Const:
Occupancy Grp:
Total $195.89
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 applicab- aw. 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 sus. ded for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those r -s are set forth in OAR
952-001-0010 through OAR 952-00 -0090. You m7 obtain a copy of the rules or direct questions to OUNC by calling 5.„ or 1.800.3 .2344.
i 4/ / ��
Issued By: ,1� `�Il d i / Permittee 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 _ 1:0112(Ilii( F ISL ONl.l
) Received -`t
City of Tigard DateB Perm"' C )
IN13125 SW Hall Blvd.,Tigard,OR 97223 p Ir� Plan Review ' lr�`
B Phone: 503.718.2439 Fax: 503.598.1960 Au 13 9 2018 Date/B : ileigi
Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Juris: ® See Page 2 for
T I G A R D Internet: www.tigard-or.gov C 3 i :, ,',GARD iO Notified/Method: Supplemental Information
TYPE OF WO 41L - (-a 1.1
TYPE PLAN REVIEW
0 New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stones.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
g'1-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
r } ❑Addition of new motor load of system.
D.7 �
Job#: Job site address: I(
O � he I.k s./e.,'t (1- 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP TGC ��^)'�� 0 Six or more residential units. occupancy.
•4 1 1 ct i G q 7 22_,:, ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'!500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
i,,� ��, ���� 1 (with above sq.ft.) 75.00 2
�- ` `V"tCiCJ e 1 G`t - �r�SLi � LC(i � Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less I 100.70 1f',., .-7C 2
201 amps to 400 amps 133.56 2
Address:
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: 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
El APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: 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 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: e. e/ le.ckf4 LLC Sign or outline lighting 67.84 Z
Signal circuit(s)or limited-energy
Address: [� l\, panel,alteration,or extension. 0 See Page 2 2
C+� � ��'lC4�Vl�j�1ti'� � .per n,
City/State/ZIP: dw f c� 7 0 l Each additional inspection over allowable in any of the above
�'v `} / ( I / 1 Additional inspection(1 hr min) 66.25/hr
Phone:a:,3 ) 7 --goe ZS Fax:( ) Investigation(1 hr min) 90.00/hr
Email:a\ f eslice ..--eieLtfi(cc I , Ccr Industrial plant(1 hr min) 78.18/hr
- Inspections for which no fee is 90.00!hr
CCB Lie.: a)(k",, Electrical Lie.: . 2, ,.1 Suprv.Lic.: Go , / specifically listed(%z hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: '
Subtotal: 17 9c'
7
Print name: e t rhe� l ;, /? 0 Plan Review Required(25%of permit fee): J/1e
u I t�3�
State surcharge(12%of permit fee): 2.0 t
Authorized signature: TOTAL PERMIT FEE: i 9 .2j 7'
permit application expires if a permit is not obtained within 180
IPrint name• I Date- I This days after it has been accepted as complete.
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11270 SW FAIRHAVEN CT, TIGARD, OR, 97223 February 12, 2019 at
9:59:52 AM
Record Type: Record ID:
Residential - Electrical ELC2018-00526
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor