Permit (117) CITY OF TIGARD ELECTRICAL PERMIT
2. COMMUNITY DEVELOPMENTIIIII
Permit#: ELC2018 00713
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/29/2018
T[C- 6. Parcel: 2S109DB02900
Jurisdiction: Tigard
Site address: 14992 SW 132ND TER
Project: US BANK Subdivision: SUMMIT RIDGE Lot: G
Project Description: Reconnect only.
Contractor: Owner: US BANK TRUST TR
BY CALIBER HOME LOANS
13801 WIRELESS WAY
OKLAHOMA CITY, OK 73134
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 10/29/2018 $67.84
Specifics:
1 ea 12%State Surcharge- 10/29/2018 $8.14
Electrical
Type of Use: SF
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 folio •- . - -dopted by the Oregon Utility Notification er. Those rules are L_fa.h in OAR
952-001-0010 throw: 952-001-0090 in- opy of the rules o direct questions to OUNC by calling 503.2 .19 or 1.800.332. .
Issued By _ ..-.. _ ermittee 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
City ofTigard Ck
Received Permit e.
IIIM 11m�iiy- !(�I,Z� /`6 . h/t 4 G_oc-70
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review co"' 0
i Phone: 503.718.2439 Fax: 503.59 '1'''_ Date/By: `� Related Permitil:
Inspection Line: 503.639.4175 Ready Datn'By: lavas: 0 Sec Page 2 for
T I G A R n Internet: www.tigard-or.gov t �,' ` Notified/Method: I &do Supplemental Information
rxPE OF wol G C y c I, PLAN ReviEw -
❑New construction ►mil Addition/alteration/ 4� A l;t Please check all that apply(submit 2 sets of plans w;items checked):
f"' '1 �} t QService or feeder 400 ampsor more
0 Demolition 0 Other: current [ Building over three stories.
Iwhere the available fault ❑Marinas and boatyards.
CATEGORY OF CON *111®� exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to round,or exceeds 14,000 Q Commercial-use agricultural
® 1-and 2-family dwelling 0 CommerciaUind al ❑Accessory building g g
0 Multi-family 0 Master builder ❑Other: 1-",-.•
amps for all other installations. buildings.
Multi-familyur•ne pwnp. O'mutilation of 150 KVA or
IJOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: I Job site address:14992 SW.132n"Ave 0 Addition of new motor load of system.
10011P or more,
I IElSix or more residential units. occupancy.
City/State/ZIP:Tigard/OR/97224 Health-care facilities. 0Recreational vehicle narks
Suite/bldg./apt.#: Project name: (A ,5-_, ,tA( I QHazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:SW Hazelcrest Way&SW 132x°Ave I FEE SCHEDULE
Description I Qty. I Each I Total I *
New r6blYs:utta!bitter or multi-family dwelling itntt.
Subdivision: Lot#: Includes attached garage.
1;000 sq ft.or less I I 168.54 I 14
Tax map/parcel#
I Ea.add'1 500 sq.ft.or portion 1 33.92 I 4 1 1
DESCRIPTION OF WORK Limited energy, 75.00 residential I 1 1
Need Electrical Panel Inspected so we can turn power on (with above sq.ft.) I
Limited energy,multi-family
75.00
residential(with above sq.ft.) }
0 PROPERTY OWNER TENANT. Renewable Energy f Q See Page 2 f
A S.
Sery r e- or feeders inatn119tion,alteration,,on relocation
Name: S- Tri,57-7 r t w� 0.• e� 1. 1ti_70 2
� TI rSr � 2
Address: I , I to- 133.56
(� 1J Yl"'�,"'S`� 401 amps to 600 amps 200.34
/State/ZIP: 2
City/State/ZIP: 46,,, ir } OK 601 amps to i 000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services orfeeders m.all ati.o n,alteration,:s•io
r
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
APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
sy.kee..f t saeis circuits axilla 1 1
Business name:AchrautaCleau EnvirounteMal of Wadaington Comity i1 e eor f fee,
brooch circuit7-42 2
Contact name:Brian Thomsen B.Fee for branch circuits without
Address: 17294 SW Galewood Dr branch circuit
City/State/ZIP:Sherwood/OR/97140 Each add'!branch circuit 7.42 2
m
InclinRe+�ldg lcerytct nr fear er Rot c1114P4)
I Phone:(503)349-5538 f14TFax::( ) Each manufactured or modular f
j dwelling,service and/or feeder I 6T84 2
Email•brian,thomgen@advnntneleauxem
"'' Reconnect only 1 67.84 67.84 2
CONTRACTOR ` Pump or irrigation circle 67.84 2
Business name:AdvantaClean Environmental of Washington County Sign se truthrte h ,ne 67.84 2
Signal circuit(s)or limited-energy 0 See Page 2 2
Address: 17294 SW Galewood Dr
panel,alteration,or extension.
City/State/ZIP:Sherwood/OR/97140 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)349-5538 Fax: ( ) Investigation(1 hr min) 90.00/hr
r ._..._ m. ._.._
Email:brian.thomsen@advantaclean.com Industrial plant(1 hr min) ` 78.1 SI hr
1 I Inspections for which no fee is I 90.00/hr
` CCH Lie.: 193086 I Electrical Lie.: I Suprv.Lie.: spwfre
:raIry rrstou(/z lir irrrrr) I I I l
ELECTRICAL PERMIT FEES
Suprv.Electrician I Subtotal: 6384
Print name: Date: 0 Plan Review Required(25%of permit fee):
7 State surcharge(12%of permit fee): 8.14
L.
Authorized signature: -.--- TOTAL PERMIT FEE: 75.98
' 17tis permit application expires if a permit is not obtained within 180
I Print name: grytd l - Iii 61'1'',.',(,.,, ' k Date: 13/4,,7 X i days after it has been accepted as complete.
Number of inspections allowed per permit.
1:1Building\Punriis\E ParnilApp ELK ERE.doc Rev00152055 151111?65,CO EWEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14992 SW 132ND TER, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Electrical ELC2018-00713
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor