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Permit (160) CITY OF TIGARD ELECTRICAL PERMIT 111 COMMUNITY DEVELOPMENT Permit#: ELC2019-00231 TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/09/2019 Parcel: 2S104CB06900 Jurisdiction: Tigard Site address: 13145 SW CREEKSHIRE DR Project: MICHAUD Subdivision: HILLSHIRE HOLLOW Lot: 22 Project Description: (1)branch circuit for A/C installation. Contractor: OWNER Owner: LAWRENCE&PAMELA DYKIER 13145 SW CREEKSHIRE DR TIGARD, OR 97223 PHONE: 509-942-8484 PHONE: FAX: FEES Quantity Description Date Amount 1 crt Branch Circuits wo/Purchase 04/09/2019 $56.18 Specifics: Service or Feeder 1 ea 12%State Surcharge- 04/09/2019 $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 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, • f work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification nter. Those rules are set forth in OAR 952-001-0010 through 952-001-0090. You may obtain - •• of the rules or direct questions to OUNC by calling 503.232. 987 or .800.332.2344. Issued By: sem.-}. — 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 USE ONLY City of Tigard Date Received y©d� 13125 SW Hall Blvd.,Tigard,OR 97223 00,1 Plan Review p ■ i, Related Permit#: _6‘,.`CtI--00 Z Phone: 503.718.2439 Fax: 503.598. T i Date/B Inspection Line: 503.639.4175 fl A(� Ready Date/By: fig' See Page 2 for T IG AK D Internet: www.tigard-or.gov • 9 3 Notified/Method: Supplemental Information Mill i91d'C�.ii�i�'i' : r ._®_ �..,�ll .... . i A Il it(ilI l��l�l 6� ,! 'I e ,;:�P� �: ........... '_ . ,d 1' -, 1i�a i !IOW t! .: ❑New construction ®Addition/alteratioleig,1.C II t ,�NSIOr' Please check all that apply(submit 2 sets of plans w/items checked): ���t 0 Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition 0 Other: L �p € ir4lfikFwhere the available fault current 0 Marinas and boatyards. 'Illi., a �'k ,t99t 'Iie a .,.w t � i !° _ •-4.� bil Ii( �i ii���i iICPll I''iG'`, exceeds 10,000 amps at 150 volts or 0 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. buildings. ❑Multi-family 0 Master builder 0 Other: ❑Fire pump. ❑Installation of 150 KVA or ar Z a_ O*107 L,Eg AwAitiTamot focb,Actiomploomplo0 Emergencysystem' larger separately derived ❑Addition of new motor load of system. Job#:001 I Job site address: 13145 SW Creekshire Drive 100HP or more. ❑"A","E","1-2", °1-3", City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy. 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#:NA 1 Project name:Dykier ❑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:Creekshire Drive and Horizon Blvd. M .7-52=-40.7_ 7 " Description I Qty. I Each I Total New residential single-or multi-family dwelling unit. Subdivision:Hillshire Hollow 1 Lot#:22 Includes attached garage. 1 0 sq.ft.or ss 168.54 4 Tax map/parcel#: Ea.Oadd'1 500 le ft orportion 33 92 I ___: , _. sq. .k= "'. IIIA �'I�a°, 1 °kI .�! , J:g t i,�ai .l IalW _ Limited energy,residential 75.00 2 Add 1 220v/30amp circuit for AC condensor (with above sq.ft.) Limited energy,multi-family residential(with above sq.ft.) 75.00 2 -' k a1z_ N bh m . A k REyinstallation, > aagned2/or relocation Name:Lawrence Dykier 200 amps or less 100.70 2 Address: 13145 SW Creekshire Drive 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP:Tigard,OR 97223 601 amps to 1,000 amps 301.04 2 Phone:(509)942-8484 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,le e,rent,or e�{r�han ,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: '4 . `\ r Date: Eid6-Kf 401 amps to 599 amps 168.54 2 nmax a � ���t Nil Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit Contact name: B.Fee for branch circuits without Address: service or feeder fee,first 56.18 no+ 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 ti= _ ,g 't4 i•''•a r'�t '�I( . u,1��Q�ri� -" �i��,�i, _� � ` `�„ , TM,� a, .� �1 i„�G���,�d��.�ir�Iu CA Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: panel,alteration,or extension. 0 See Page 2 2 Each additional inspection over allowable in any of the above City/State/ZIP: Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr Industrial plant(1 hr min) 78.18/hr Email: Inspections for which no fee is 90.00/hr s.ecificall listed '/2 hr min CCB Lic.: Electrical Lic.: Suprv.Lic.: rmarwmw Suprv.Electrician signature,required: Subtotal: Print name: I Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: 44.—C). Pai�t� ' This permit application expires if a permit is not obtained within 180 Print name: Lawrence Dykier Date: 4/4/19 days after it has been accepted as complete. * Number of inspections allowed per permit. L\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(II/05/COM/WEB