Permit (180) CITY OF TIGARD ELECTRICAL PERMIT
Is . COMMUNITY DEVELOPMENT Permit#: ELC2018-00604
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/13/2018
T r�'A I+:[� 9 Parcel: 1S133DA03700
Jurisdiction: Tigard
Site address: 12545 SW GLACIER LILY CIR
Project: KRAAKEVIK Subdivision: AMART SUMMER LAKE Lot: 59
Project Description: Adding(2)branch circuits to laundry room and bathroom.
Contractor: R&D ELECTRIC INC Owner: KRAAKEVIK,JEFF&SUSAN
PO BOX 868 12545 SW GLACIER LILY CIR
MULINO, OR 97042 TIGARD, OR 97223
PHONE: 503-679-7987 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 09/13/2018 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/13/2018 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 2-001-0090. You - -y obtain a .py of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: SLI / Permittee Signature: 4cV6-17A—c
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 OF'FR- F l si.011.1'
OR 97223 Q Received ���
rzipplepg
13125 SW Hall Blvd.,Tigard,
a
City of Tigard
" r, Plan Review
ll Phone: 503.718.2439 +,-, :' ' Date/13 : Related Permi / ki
Email: TigardBuildingPermits@Tigard-or.gov Ready Date By: Jurb: Bl See Page 2 for
I 1 G A h D Inspection Line: 503.639.4175 Internet,, ww:w.ligard-or.gov Notified/Method: Supplemental Information
PE OF WORK
PLAN REVIEW
0 New construction Bi 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 stories.
❑Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
1-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.
❑Multi-family 0 Master builder 0 Other: buildings.
0Fire pump. 0Instdings.
Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: ( Job site address: j 6 i.16 so G lacye,- �,i y 100HP or more. ❑"A","E","I-2","l-3",
occu nc
City/State/ZIP: /
El Six or more residential units. Pa Y-
%L(a rd / 7,,,.2.23
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: ✓ Project name: 0 Hazardous locations. 0 Supply voltage for more than
l'S'AGl Q t ❑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.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential 75.00 2
i c�� (with above sq.ft.)
`-/-1-WI-47J� �� G V�y� CA-A.- Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
111 Renewable Energy ❑ See Page 2
0 PROPERTY OWNER` I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 snips 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) 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
0
APPLICANT `CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A Fee for branch circuits with
Business name: Lal tv C�XlCvG.'�Ian -`-i,.�c above service or feeder fee, 7.42 -7- 2
each branch circuit
Contact name; `-uS Y`t La,
n, B.Fee for branch circuits without I
Address: G 1 service or feeder fee,first I 56.18 .-6 2
�.�f'j 111) MAl-v+i C e. I G C branch circuit
City/State/ZIP JF .r1 ®e ac�1,l. Each add'I branch circuit 7.42 2
c.
Miscellaneous(service or feeder not included)
Phone:(603)31, cs,Le le GI Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:lC. n4fey14 Vic`#-1111- /�tg in C Lt/ / (na4 1,Cts Reconnect only 67.84 2
CONTRACTOR' Pump or irrigation circle 67.84 2
Business name: ‘...k.,, p I ro C� r...c_ T Ju C Sign or outline lighting 67.84 2
V 1 a l Signal circuit(s)or limited-energy
Address: \3&4 L�5 �+ �� `'� panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP. �� PA IA-11100 of Each additional inspection over allowable in any of the above
�� Ce., � +�?
4:1 -? , Additional inspection(1 hr min) 66.25/hr
Phone:(S3) `-)67-0I C e 7 Investigation(I hr min) 90.00/hr
Email: 1..�.tQ °`�J'`t �. _
Industrial plant(1 hr min) 78.18/hr
` "-1i� ` b �? Inspections for which no fee is 90.00/hr
CCB Lic.:113 tui/ lectrical Lie.:C -5o Suprv.Lic.:5��1.�,+s specifically listed('lz hr min)
t 1`4' �1�. ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: V eS ,,....)..,,,,,>, �� Date:9_II_ ( if 0 Plan Review Required(25%of permit fee): _
State surcharge(12%of permit fee):
Authoriz si atu TOTAL PERMIT FEE: 7/_237
3
This permit application expires if a permit is not obtainewithin 180
Print naive. Date: ,�,i-\ „-\
` ` - * Number of inspections allowed per permit.
l'Building'Pmnits\ELC_PermitApp_ELR ERE.doc Rev 10x26/2017 440-4615T(11/05/COKWEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12545 SW GLACIER LILY CIR, TIGARD, November 20, 2018 at
OR, 97223 9:08:46 AM
Record Type: Record ID:
Residential - Electrical ELC2018-00604
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor