Permit (157) CITY OF TIGARD ELECTRICAL PERMIT
3. COMMUNITY DEVELOPMENT Permit#: ELC2019-00351
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/23/2019
Parcel: 2S106DC04600
Jurisdiction: Tigard
Site address: 17171 SW JEAN LOUISE RD
Project: Bonifacio Subdlvision:POLYGON AT WEST RIVER TERRACE Lot: 46
Project Description: Reconnect only.
Contractor: Owner: BONIFACIO, MELISSA REINNA
BONIFACIO, DARWIN LAWRENCE
17171 SW JEAN LOUISE RD
SHERWOOD, OR 97140
PHONE: PHONE: 831-999-0379
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 05/23/2019 $67.84
Specifics:
1 ea 12%State Surcharge- 05/23/2019 $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 follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 5503.232.1987 or 1.800.332.2344.
Issued By: n Permittee Signature: N _\C-\1\17► 1
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 1 (h it t)i iii 1 ,,, 0\i N
City of Tigard Received
D S\a3 1 to, . T• #-E1, - k
13125 SW Hall Blvd.,Tigard,OR 97223 MAY 2 e Z O 19 plan Review
' g • Phone: 503.718.2439 Fax: 503.598.1960 Date/By.. Reed Permit a:
Inspection Line: 503.639.4175 -,n �/ , 1 -' Date/By kris: g See Page 2 for
"` " " Internet: www tigard•ot'.gov of d/Method: Supplemental lufermatlaa
aulLoiNG olvislg d
.4:w» i!?k«;i...yC«: �.9 .omic,.ria U,. . .e.., , ..... ^ -:: :t.i .liar..a4 �,,3_ v. +#.'..t`v. '.}..FR 4 ',
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❑New construction 0 Addition/alteration/replacement Please check all dot apply(submit j sats of plns wTaems checked):
1]Service or feeder 400 amps or more 0 over three
❑Demolition 0 Other: where the available fault current 0 Marinas stories.
and boatyard
�.,�'` „• T '� , .F t NN'TRU ON . : exceeds 10,000 a at ISO volts or 0 Floating buildings.
Lis 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to s«md,or exceeds 14,000 0 ceavaacial-use agricultural
amps for an other installations. buildings.
❑Muhl-family ❑Master builder ❑Other: ❑Fire pump. ❑installation of 150 KVA or
401 == ci8MATJON �R)<a:�'. ( Ttol+t . : : ,J ❑Emergency larger sepa�elyd ed
1 JC4 Limq, Ffi1, ❑Addition more.f new �lead of
Job#: Job site address: looFiP a more. O"A","E","1-2","1-3".
C' /State/ZIP: Atrvicbc\ 0 sir or more residential twits. Y•
1 �^ ti� OFhdth cffie facilities 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 tamps or more. 600 volts nominal.
Cross street/directions to job site: 1 e FEE S+CIIFDIiLE `;
Description I on. I lack 1 Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ftor lass 168.54 4
Ea.add'1500 sq.ft.or portion 33.92 1
�.: DE7ION OF WORK Limited energy,residential
rp ��.I► A011-1
t` (with above sq.ft.) 75.00 2
s�il.(Jl�ll v't„ Limited energy,multi family
residential(with above sq.ft) 75.00 2
4o1' tfl X r �i Renewable Energy See Peet 2
TENANT Services or feeders installadon,alteration,and/or relocation
Name: .1c� \ eh 200 amps or foes 100.70 2
Address: A, ,t `4 12,c4 201 amps to 400 amps 133.56 2
_ `j { �� • 401 amps to 6th a 200.34 2
City/State/ZIP:%�JMA tOIC 601 amps to 1,000 amps 301.04 2
Phone:( �) _ 0 Fax:( )
Over 1,000 amps or volts 552.26 2
Email: / • r(+ta i Temporary services or feeders installation,alteration,and/or
v I7� relocation
r1
tallation is be' made on that I own which is not 200or leas 59.36
Owner assts anon:This ms iqg� property amps
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
;.q ,ABranch circuits—new,alteration,or extension,per panel
r .:i._ ti,. fir, _ 1 GQIVTJ CCP RSbN A.Foe 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 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder ant included)
Phone:( ) Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect onlyii 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting _ 67.84 2
Address: Signal circuit(')°r lintite I.nergy (3 See Page 2 2
panel,alteration,or extension.
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 90.00t hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(Yl hr min)
ELECTRICAL PERMIT FEES _;
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:
i,,i ` This permit application expires if a permit is not obtained within tan
Print name: AR4/,►( f l i. • s 1 4 b Date: T) c) 1 if days slier it hes been accepted as complete.
•.v11VV VVV»>�(J� + Number of inspections allowed per permit.
44946151( , or ,S:
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
ItiriSIDENTIALW1l11IONIS: ,. > .,,. *:! "
Fee for residential systems combined: $75.00 Rena �`'' EachTia �
Y Renewable electrical energy system=
Check Type of Work Involved: s kva or leas 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 290.34 2
Wind generation systems in excess of 25 kva:
0 Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.2 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning sola, eneration
g systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kve-no additional charge 0.0 3
Each additional Inspection over allowable In any of the above:
O Each additional inspection is
Other: charged at an hourly(1 lir min)
6625/hr
Inspections for which no foe is 00/
hr
specifically listed 1!5 hr min
444 RICONLY' 4i#i;.
Subtotal(Eater on Page 1): I
Fee for Bach commercial system: $75.00 , Number of inspections allowed per pecan.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
O Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
O Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: —
*No licenses are required. Licenses are required for all
other installations
1:tEauldiag\Peimits\ELC_PnmitApp ER ERE.doe Rev 06/172015
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
17171 SW JEAN LOUISE RD, SHERWOOD,
OR, 97140
Record Type: Record ID:
Residential - Electrical ELC2019-00351
Inspection Type: Inspector:
199 Electrical final David Young
Result:
FA I L
Comments:
No access for re connect inspection.
House locked, no access information left with inspection request.
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
17171 SW JEAN LOUISE RD, SHERWOOD,
OR, 97140
Record Type: Record ID:
Residential - Electrical ELC2019-00351
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Inspection for re connect ok.
Meter green tagged.
Violation Summary:
Inspector Contractor