Permit (89) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2019-00075
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/12/2019
T r c It.r', g Parcel: 2S108DB06000
Jurisdiction: Tigard
Site address: 15369 SW SEINE DR
Project: DANA Subdivision: POLYGON AT BULL MOUNTAIN Lot: 58
Project Description: (1)branch circuit for bathroom timer and light for shower.
Contractor: OWNER Owner: DANA,JUBIN
JUBIN DANA 15369 SW SEINE DR
15369 SW SEINE DR TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 650-387-0003 PHONE: 650-387-0003
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 02/12/2019 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 02/12/2019 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 - •her apps able 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 - if work is su/e r:-d for more the 180
days. ATTENTION: Oregon law require you to follow the rules adopted by the Oregon Utility Notification 'enter. Thos- are set forth in OAR
952-001-0010 through R 952-0 1-0090. ou may ob-' a copy of the les or direct questions to OUNC by calling 50 ' 2.1987 or 1.800.33 44.
Issued By: �(�. 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 FOR OFFICE 1 SF OyLI
City o Tigard J3ECEIVED R'
4, g Date/B i /WI
F,� Permit# L)i I'TC7
1111 q 13125 SW Hall Blvd.,Tigard,OR 97 Plan Review
_ Phone: 503.718.2439 Fax: 503.598.1969_r- Date/B : Related Permit 4:
Inspection Line: 503.639.4175 f C 12 2019 Ready Date/By: !Mil ® See Page 2 for
TIGARD Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF TIGARD PLAAI REVIEW
TYPE OF �J171NG DIVISION .:'.
❑New construction X Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other: ❑Service or feeder 400 amps or more ❑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.
1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB.SECT INFORMATION AND' LOCATION - 0 Emergency system. larger separately derived
Job#: Job site address: [_3 6 cif S IA)
ST/�1�`O R ❑Addition of new motor load of system.
J 100HP or more. 0"A","E","1-2","1-3",
.---
City/State/ZIP: / /61R6
/1/.O / /?, ❑Six or more residential units. occupancy.
211- ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Pmject name: D, /J'I 7 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'I 500 sq.ft.or portion 33.92 1
RW4 .. . Limited energy,residential
/( �/ (with above sq.ft.):
J 75.00 2
/1 � l�+!�� Q U 1 ; (r{NG� ��(JWr/,9W Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
)4,PROPERTY 01'YNER Renewable Energy ❑ See Page 2
j 7ENANI Services or feeders installation,alteration,and/or relocation
Name: 0&'t y ,! a 200 amps or less 100.70 2
I" ® 201 amps to 400 amps 133.56 2
Address: ( 3 401 amps to 600 amps 200.34 2
City/State/ZIP: I /6;k12(`
� 61_ 9 7-2 2f" 601 amps to 1,000 amps 301.04 2
Phone: S()) 3 U 1. -C463 Fax:( ) Over 1,000 amps or volts 552.26 2
�, Temporary services or feeders installation,alteration,and/or
Email: C&Ac d_1713i/AV L..)-'14 r t CCM
W relocation
Owner installation:This install. is b-ri g m;de on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent • exchang ii..r : ding to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: /+ Date: Z//2.1 i CI 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: 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 SZ./. 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: Sign or outline lighting 67.84 2
Signa
Address: panel,, o
r alteration,or extension.❑ See Pa2 2
ion. ge
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(%hr min)
ELECTRICALS rit•RW FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): QQ v (e."")+.
Authorized signature: TOTAL PERMIT FEE: i$CA>q,,
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* TT...../......f:....o.µ:........11....,0.7.........-.+:.
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15369 SW SEINE DR, TIGARD, OR, 97224 March 7, 2019 at 9:58:59 AM
Record Type: Record ID:
Residential - Electrical ELC2019-00075
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor