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Permit (30) CITY OF TIGARD ELECTRICAL PERMIT S. COMMUNITY DEVELOPMENTIIII Permit#: ELC2019-00056 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/04/2019 TIGARD Parcel: 1S135DD03616 Jurisdiction: Tigard Site address: 11440 SW LOMITA AVE Project: Ameritrust-LOMITA Subdivision: LOMITA TERRACE Lot: 15 Project Description: (1)panel replacement with(8)branch circuits. Contractor: G&H ELECTRICAL CONSULTING LLC Owner: AMERITRUST RESIDENTIAL SERVICES PO BOX 12901 3630 PEACHTREE ROAD NE SALEM, OR 97309 13801 WIRELESS WAY ATLANTA, OK 30326 PHONE: 503-302-3354 PHONE: 503-313-7793 FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders-200 02/04/2019 $100.70 Specifics: amps or less 8 crt Branch Circuits w/Purchase 02/04/2019 $59.36 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 02/04/2019 $19.21 Electrical Type of Const: 1 ea Investigation Fee 02/04/2019 $90.00 Occupancy Grp: 1 ea Investigation 12%State 02/04/2019 $10.80 Surcharge Total $280.07 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 r. - adopted by the Oregon Utility Notification Center. Those r es are set forth in OAR 952-001-0010 throughOAR952-001-0090. Y. •• -a c•.y of the r s or direct questions to OUNC by calling 503 ..1987 or 1.800.33 . 344. ir Issued By: ,ri�,r__,— .— - _ /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 503.639.4176 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 OFFICE USE ONLY City of Tigard '- -ived RECEIV: B . i4 111 13125 SW Hall Blvd.,Tigard,OR 97223 • n Review Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#: V` it_ r„I,,t 4201' TIGARD Inspection Line: 503.639.4175 JAN Ready Date/By: H See Page 2 for Internet: www.tigard-or.gov Notified/Method: WPM' Supplemental information CITY OF TIGARD TYPE OF WORK PTN REVIEW ❑New construction BUILDINOacementDIVISION Please check all that apply(submit 2 sets of plans w/items checked): ®Addition/alteration/replacement ❑Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards. I— _►TEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ,may 1-'cYI1d�=I�411q 8'wwg j „Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑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 INFORMATI©N AND LOCATION 0 Emergency system. larger separately derived AddJob#: Job site address: 11440 SW Lomita Ave ❑1100Hoo of new motor load of system. 00HP or more. ❑"A","E","1-2","1-3", City/State/ZIP:Tigard,OR 97223 0 Six or more residential units. occupancy. ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name:Ameritrust 0 Hazardous locations. 0 Supply voltage for more than 0 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 * LN,14)ti l/? 6 d Ott � *^'I 5 1�'J:s 'a0( New residential single-or multi-family dwelling unit. Subdivision: N C.„',ea� f77,,:i , i, 4,1 Lot#: Includes attached garage. t ,if 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: t f,,li,tain-,j �,,sf sf 3� � .�fr� ,� Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK d"ezi - ' Limited energy,residential 75.00 2 Replace electrical panel with new.Update bonding and grounding.Replace AC D /Y/F (with above sq.ft.) Limited energy,multi-family sconnect and whip.Replace old plugs and switches.Hook up Furnace il=f; residential(with above sq.ft.) 75.00 2 Renewable Energy 0 See Page 2 0 PROPERTY OWNER I 0 TENANT ' Services or feeders installation,alte ation,and/or relocation Name: 200 amps or less — I100.70 /Oa7(rj 2 Address: 201 amps to 400 amps 133.56 2 401 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 APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name:G&H Electrical Consulting,LLC above service or feeder fee, '8 7 42 S t 3i 2 each branch circuit Contact name:Yev Gerasimenko B.Fee for branch circuits without Address:PO BOX 12901 service or feeder fee,first branch circuit L I L_ City/State/ZIP:Salem OR 97309 Each add'I branch circuit 2 Miscellaneous(service or feeder not included) Phone:(503)302-3354 Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email:yev@gh-electrical.com Reconnect only 67.84 2 CONTRACTOR • Pump or irrigation circle 67.84 2 Business name: G&H Electrical Consulting,LLC Sign or outline lighting 67.84 2 Address:PO BOX 12901 Signal circuit(s)or limited-energy 0 See Page 2 2 panel,alteration,or extension. City/State/ZIP:Salem OR 97309 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(503)302-3354 Fax:( ) Investigation(1 hr min) 90.00/hr ‘10,L5 Industrial plant(1 hr min) 78.18/hr Email:yev@gh-electrical.com Inspections for which no fee is CCB Lic.: 204826 l Electrical ic.: C1073 uprv.Lic.: 5987S specifically listed(Y2 hr min) 90.00/hr ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: ' Subtotal: 5D-(,) / Print name: Yev Gerasimenko " Date: 2/2/19 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): 30 .C)j Authorized signature: TOTAL PERMIT FEE: 07 This permit application expires if a permit is not obtained within 180 Print name: yev gerasimenko Date: 2/2/19 days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11440 SW LOMITAAVE, TIGARD, OR, 97223 Record Type: Record ID: Commercial - Electrical ELC2019-00056 Inspection Type: Inspector: 199 Electrical final Jeff Grove Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11440 SW LOMITAAVE, TIGARD, OR, 97223 February 5, 2019 at 9:35:02 AM Record Type: Record ID: Commercial - Electrical ELC2019-00056 Inspection Type: Inspector: 199 Electrical final David Young Result: FA I L Comments: Not ready for final inspection. Kitchen appliances not installed or connected at this time. Wires in panel not saved off. Contractor on site still working in panel. Violation Summary: Inspector Contractor