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Permit (183) CITY OF TIGARD ELECTRICAL PERMIT 74 '- Permit#: ELC2018-00573 �' COMMUNITY DEVELOPMENT 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/29/2018 T f C;;ti I<C� g Parcel: 1S136CB03100 Jurisdiction: Tigard Site address: 11265 SW 83RD AVE Project: PIMENTEL Subdivision: STEVE&HUGHIE'S PLACE Lot: 3 Project Description: Adding(4)branch circuits for garage door,kitchen GFI,bathroom GFI,and outdoor. Contractor: NORTHWEST EDISON Owner: PIMENTEL, MARK 19804 141ST PLACE NE 11265 SW 83RD AVE WOODINVILLE,WA 98072 TIGARD, OR 97223 PHONE: 425-806-9200 PHONE: 503-709-7021 FAX: FEES Quantity Description Date Amount 4 crt Branch Circuits wo/Purchase 08/29/2018 $78.44 Specifics: Service or Feeder 1 ea 12%State Surcharge- 08/29/2018 $9.41 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $87.85 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. You may obtai -copy of the les or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: i�«/�. ��/,L`✓ 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. ` is AU3 2 , t��201 8Q ¢SJ Electrical Permit Application 11111111111 CityofTigard L. Received , t Date/By: //to Permit#: i • 0 111 • 13125 SW Hall Blvd.,Tigard,OR 97223 Pian Review a Phone: 503.718.2439 Fax: 503.598.1960Date/By: Related Permit#: Inspection Line: 503.639.4175 ReadyDate/By: Reis:l 1 c; \RLD w Internet: ww .tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK - PLAN REVIEW ❑New construction 15?Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): Ill Demolition 0 Service or feeder 400 amps or more 0 Building over three stories. �� where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. 54 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation o£150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived ` a3rd�J�- ❑Addition of new motor load of system. Job#: Job site address: It S 5( ) D 100IIP or more. ❑"A"."E", 1-2","I-3 City/State/ZIP: ` 1 dart A t d q 12.1,3 ❑Six or more residential units. occupancy. 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than n �� 0 Service or feeder 600 amps or more. 600 volts nominal. Cross stye. ...._ctions to job site:~�j e2) �7 ya!,}� 5 FEE'SCHEDULE 1t �_ } Description 1 . INEEMIN Total j 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'1500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential � p t ` with above s ft. 75'00 2 6 ant nt Qu i 4• I.Z t Er tbQ 7 L&itk q.i Limited energy, ti-family residential(with above sq.ft.) 75.00 2 0 PROPERTY OWNER 0 TENANT Renewable Energy 0 See Page 2 Services or feeders installatio; alteration and/or relocation Name: KAOxtf- -pi yy(Q44.411 200 amps or less 100.70 allIll 2 Address: 1t2-(Q!S` 5 l� g ret Pt U 201 amps to 400 amps 133.56 City/State/ZIP: 401 amps to 600 amps 200.34 Ell y Ttctar�Pl IL 1zL3 dd 601 amps to 1,000 amps IIIII 301.04 Eii Phone:(5d'3) l oci-10.2...t Fax:( ) Over 1,000 amps or volts IIIIIIMII2 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 I intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 Owner signature: Date: 401 amps to 599 amps 168.54 In Q APPLICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,par panel - A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit Contact name: B.Fee for branch circuits without Address: service or feeder fee,first branch circuit 1 56.18 3-4), tX 2 City/State/ZIP: Each add'l branch circuit 3 7.42 22 2 _Miscellaneous(service or feeder not included Z Phone:( ) Fax::( ) Each manufactured or modular Email: II dwellt�gn service and/or feeder 67.84 Reconnect only 11111 67.84 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: n Sign or outline lighting Ill67.84 2 Address:11807 North Creek Parkway South Suite 8-103 Signale,circuits}or lextensionergy o See Page 2 —© panel,alteration,or extension. City/State/ZIP:98011 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(425)806-9200 Fax:(425)806-7455 Investigation(1 hr min) - 90.00/hr ■ Email:sinjina(k?nwedison.cosn 7 ' ' `�/1 ) industrial plant(1 hr min) 78.18/hr —'" Ip�� `7 Inspections for which no fee is • CCB Lie.: 187903 v1 1 (' Electrical Lic.: C940 Suprv.Lie.: 5920S s•-ificoll listed i hr mitt 90.00/hr fili�' ELECTRICAL PERMIT FEES Suprv.Electrician signature,required - ,` Print name: Leonard Anterolaerr (25% fee): 'l , 4T Date: 8/27/2018 0Plan Review Required of permit fee): State surcharge(12%of permit fee): 9 t 4( Authorized signature: TOTAL PERMIT FEE: '7r gc' 1 This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. " Number of inspections allowed per permit. I:'SSsitdinglPrnnits5I..C_PerrtitApp_EI.tt_ERE.doc Rev 06/17:2015 440-46t5r(I t.'o5COMRNEB City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11265 SW 83RD AVE, TIGARD, OR, 97223 Record Type: Record ID: Residential - Electrical ELC2018-00573 Inspection Type: Inspector: 199 Electrical final Jeff Grove Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor