Permit (40) CITY OF TIGARD ELECTRICAL PERMIT
- COMMUNITY DEVELOPMENT
Permit#: ELC2019-00407
Date Issued: 06/17/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S104DB05200
Jurisdiction: Tigard
Site address: 13275 SW GREENFIELD DR
Project: LEBRUN Subdivision: None Lot: None
Project Description: (5)branch circuits for kitchen remodel.
Contractor: DICKINSONS ELECTRIC Owner: LEBRUN,TIMOTHY LIN &SUSAN MARI
8449 SW BARBUR BLVD 13275 SW GREENFIELD DR
PORTLAND, OR 97217 TIGARD, OR 97223
PHONE:
PHONE: 503-246-3550
FAX: 503-213-6049
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo/Purchase 06/17/2019 $85.86
Specifics: Service or Feeder
1 ea 12%State Surcharge- 06/17/2019 $10.30
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
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 'es a•op by the Oregon Utility Notification Center. Thos .- are set forth in OAR
952-001-0010 through O,r ' 2-001-0090. You ma obt- - •. of the rules or dire. questions to OUNC by calling 503.232. r"1"IlO' • .
Issued By: Permi re,
41111111/ 111
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
City of Tigard RECEIVE
eceived // permit#: t
III13125 SW Hall Blvd.,Tigard,OR 97223 - ate/By: (��/ 7�/efi L(.v��`f`613
7C�
g Plan Review
I Phone: 503.718.2439 Date/By: Related Permit#: t LM y1 L}19._ ) 1'4o
Email: TigardBuildingPermits@Tigard-or.gov JUN Ready Date/By: Jure ® See Page 2 for
T I L.A R D 2�Inspection Line: 503.639.4175 Internet: www.tigard-or. ov Notified/Method: Supplemental
pplemental Inform
ation
- ry01— oAo
TYPE OF WO epDIVISION PLANREVIEW
❑New constructionition/alterati epuicement Please check all that apply(submit asets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition Cl Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
`_and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: I Job site address:>l Z. 7 6 y��`x�1�L jdi 100HP or more. ❑"A„ "E> "1.2> °°1.3„
City/State/ZIP: ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: / 0 Hazardous locations. 0 Supply voltage for more than
Le t l�t`�1/�
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. 1 Each 1 Total
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
/( 1�,'- (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
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: Tl�07-72 - J4 a..YV� . / 200 amps or less 1 100.70 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:( ) 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 I 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 I 0 CONTACT PERSON 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
branch circuit 56.18 Ly 2
City/State/ZIP: Each add'l branch circuit 11 7.42 6Y 2
Miscellaneous(service or feeder not included)
Phone:( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTR.W.TO Pump or irrigation circle 67.84 2
Business name:/ 1 f�`� /�' Sign or outline lighting 67.84 2
�y� s` /� � ��� Signalnel,circuit(s)errn or extension.
0 See Page 2 2
Address: izz �/v- ,< panel,alteration,or extension.
/ ,v�
Each additional inspection over allowable in any of the above
City/State/ZIP:
�CJ��� / G/ Additional inspection(1 hr min) 66.25/hr
Phone:(9 2`.. 2 b a lam-' Investigation(I hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
P
' /
Inspections for which no fee is
specifically listed ''/hr min 90.00/hr
CCB Lib 63 lQ I Electrical Lik:b >r I Suprv.Lic..`j/`2 j pec y ( )
7/ ,J ELECTRICAL PERMIT FEES
Suprv.Electrician signature,r-, • =:.y_— _.--- -------' Subtotal: ,ff5' V-
Print name ! API), e/ —/ El Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): /0. ,?
Authorized signature: TOTAL PERMIT FEE: 76, ,Az
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WO Y: FEE SCHEDULE
I
Fee for all residential systems combined: $75.00 Dere Earn Totat
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ 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
with OAR 918-309-0040) 552.26 2
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100kva—noadditional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
T . NLY: £ >" i specifically listed '/z hr min
w AL PERM `'FEES'
�
Subtotal(Enn Page 1):
Fee for each commercial system: $75.00
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ 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
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
13275 SW GREENFIELD DR, TIGARD,
OR, 97223
Record Type: Record ID:
Residential - Electrical ELC2019-00407
Inspection Type: Inspector:
199 Electrical final David Young
Result:
FA I L
Comments:
No power to kitchen plugs, gfci's not re setting unless island gfci is tripped.
With island gfci tripped, gfci by dining area shows possible hot/ ground or hot/
neutral reversed.
Re call after corrections complete.
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
13275 SW GREENFIELD DR, TIGARD,
OR, 97223
Record Type: Record ID:
Residential - Electrical ELC2019-00407
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Correction complete.
Violation Summary:
Inspector Contractor