Permit CITY OF TIGARD ELECTRICAL PERMIT
•
COMMUNITY DEVELOPMENT Permit#: ELC2019-00096
RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/20/2019
TIG °" 9 Parcel: 2S 111 DC11800
Jurisdiction: Tigard
Site address: 15870 SW OAK MEADOW LN
Project: ABBOTT Subdivision: SUMMERFIELD NO.11 Lot: 614
Project Description: (11)branch circuits for interior remodel.
Contractor: GORE ELECTRIC COMPANY Owner: ABBOTT FAMILY TRUST
24658 SW DANIEL RD ABBOTT SURVIVOR'S TRUST
BEAVERTON, OR 97078 BY ABBOTT, MORAG E TR
15870 SW OAK MEADOW LN
TIGARD, OR 97224
PHONE: 971-998-3215 PHONE:
FAX:
FEES
Quantity Description Date Amount
11 crt Branch Circuits wo/Purchase 02/20/2019 $130.38
Specifics: Service or Feeder
1 ea 12%State Surcharge- 02/20/2019 $15.65
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $146.03
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 t adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090.rYYrni ma obta' ' copy of the rul-s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: . . _ - ee 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 OH'IC1: t SE Oy1.A
City of Tigard Received WilIMIMMINI
DateB : . !A t is i
13125. SW Hall Blvd.,Tigard,OR 97223 Plan Review
! Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit 4:
FIG D Inspection Line: 503.639.4175 e,' 'eady Date/By: � H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: EMI
Supplemental Information
TYPE OF WORTe\N�Q19 PLAN REVIEW
❑New construction ®Addition/alteration/replac-r"i nQ% Please check all that apply(submit 2 sets of plans w/items checked):
• 0 0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: e 1\GPP; N where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCT'. N( 0•
G Q\v\5 exceeds 10,000 amps at 150 volts or 0 Floating buildings.
X1-and 2-family dwelling 0 Commercial/industrial r h ssory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
C3 amps for all other installations. buildings.
❑Multi-family El Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#:19007 Job site address: 15870 SW Oak Meadow Ln 100HP or more. ❑"A">"E "1-2","t-3",
City/State/ZIP:Tigard,Or.97224
0 Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Oak M ane Remodel �j 0 Hazardous locations. ❑Supply voltage for more than
.� �✓ ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:SW Alderbrook off Durham 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'l 500 sq.ft.or portion 33.92 l
DESCRIPTION OF WORK Limited energy,residential 75.00 2
Additional lighting,relocate receptacles for new layout of cabinetry.Re-route (with above sq.ft.)
Limited energy,multi-family 75.00 2
homeruns to run above trusses after removed soffit. residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: .4-�"9cl t f ..„ ,F,1 /T s.y— 200 amps or less 100.70 2
Address: II ++ 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
0 APPLICANT CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Gore Electric Company above service or feeder fee,
7.42 2
each branch circuit
Contact name:Darrell Gore B.Fee for branch circuits without
service or feeder fee,first 1 56.18
Address:24658 SW Daniel Rd. branch circuit 56.18 2
City/State/ZIP:Beaverton,Or.97078 Each&d'1 branch circuit 10 7.42 74.20 2
Miscellaneous(service or feeder not included)
Phone:(971)297-8198 Fax: :( ) Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email:darrell@goreec.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Gore Electric Company Sign or outline lighting 67.84 2
Address:24658 SW Daniel Rd. Signalecircuit(s)lern or limited-energy
0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP:Beaverton,Or.97078 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(971)297-8198 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:darrell@goreec.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 223107 /l/1 1A) Electrical Lic.• C1410 //l/it Supry'{(\Lic.: 5525S i,)//li l specifically listed(/2 hr min) 90.00/hr
/ �;\- Ai ��J/�I�C l ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 130.38
Print name: Darrell Gore Date: 2/20/19 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 15.65
( (S TOTAL PERMIT FEE: 146.03
Authorized signs re: �L9.,
This permit application expires if a permit is not obtained within 180
Print name:K,V -tj(` Date: 2/20/19 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\BuildinglPermits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
15870 SW OAK MEADOW LN, TIGARD,
OR, 97224
Record Type: Record ID:
Residential - Electrical ELC2019-00096
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
15870 SW OAK MEADOW LN, TIGARD,
OR, 97224
Record Type: Record ID:
Residential - Electrical ELC2019-00096
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor