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Permit (59) CITY OF TIGARD ELECTRICAL PERMIT " . COMMUNITY DEVELOPMENT Permit#: ELC2019-00443 T I(J A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/27/2019 Parcel: 25111 DB03900 Jurisdiction: Tigard Site address: 9195 SW SUMMERFIELD CT Project: POOLE Subdivision: SUMMERFIELD NO.8 Lot: 426 Project Description: Adding(1)branch circuit to new bathroom. Contractor: KVA ELECTRICAL LLC Owner: POOLE, REBECCA A PO BOX 12069 9195 SW SUMMERFIELD CT SALEM, OR 97309 TIGARD, OR 97224 PHONE: 503-689-4822 PHONE: 503-468-9654 FAX: FEES Quantity Description Date Amount 1 crt Branch Circuits wo/Purchase 06/27/2019 $56.18 Specifics: Service or Feeder 1 ea 12%State Surcharge- 06/27/2019 $6.74 Type of Use: Electrical Class of Work: 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. 1-,'s permit wi expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law require yo� • follow he ruleesopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through 007-001.,,_.-Yo y obtain- •py of t les or di -n . estions to OUNC by calling 503.232.1987 1.800.332.2344.9 Issued By: " /� � = 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()N1,1- City of Tigard Received I � / � IDate/B : 4L . - 11 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/B : • j� , p�y Inspection Line: 503.639.4175 Ready Date/By: Juris: Vi See Page 2 for T I G A R D Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑New construction *Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards. cATEO00 OF CONSfittienoN exceeds 10,000 amps at 150 volts or 0 Floating buildings. dwellingless to ground,or exceeds 14,000 0 Commercial-use agricultural 1-and 2-familygr 0 Commercial/industrial 0Accessory building amps for all other installations. buildings. Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or 10B SITE mmudArioNlAND LocAnori 0 Emergency system. larger separately derived Job site address: / �} f•i ❑Addition of new motor load of system. Job#: q' l,c S'(As(f NT it't rEL14 r 100HP or more. ❑,.A„ .,E„ ,.1.2" .,1.3„ t� Gj Six or more residential units. occupancy. City/State/ZIP: /1&t ye") Q�? < 7 ZZ"y 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: I Project name: S pi,y'`r✓j e 447 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: $LJ S/1.-7-TL.E/2_ S% FEE SCHEDULE <. Description I Qty. I Each j Total... I 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'l 500 sq.ft.or portion 33.92 1 DINCRIP'IION OF"' Limited energy,residential (with above sq.ft.) 75.00 2 /4041. 1 (...JI/ /— 20p C.1 c i LSC` Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy 0 See Page 2 PROPERTY OWNER `.NT Services or feeders installation,alteration,and/or relocation Name: f.M S P1"z r6S 1. ,j-t4 c_S t—C.-C 200 amps or less 100.70 2 Address: /3 yd A-127€ Z A-CH �v J'� 201 amps to 400 amps 133.56 2 /I / 401 amps to 600 amps 200.34 2 City/State/ZIP: /./ /Jvc jrto OP-,, 971 Zy 601 amps to 1,000 amps 301.04 2 Phone:(503) 3 60_9 2 4 6 J 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 eogi APPLICANT1 d CONTACT PERSON Branch circuits-new,alteratioor extension,per panel . A.Fee for branch circuits with n, Business name: A E�GT%2.( _ (_C above service or feeder fee, ,M each branch circuit 7.42 2 Contact name: /"' I lc 6- B.Fee for branch circuits without service or feeder fee,first 56.18 (Q 2 Address: pc) • x /2_06 9 branch circuit CJ City/State/ZIP: SA-L'cv/ 0/ -- 9'7_i Q g Each add'l branch circuit 7.42 2 1Miscellaneous(service or feeder not included) Phone:(SC33) 3 e3 / 6 o Z Fax: :( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: G-T/Z/ L (_L C. ee oki-,.4-i L. a ei 144 Reconnect only 67.84 2 CONTRACTOR " , , Pump or irrigation circle 67.84 2 - Business name: Xj/A (-G St or outnne lighting67.84 2 Address: f� (� Signalalteration, circuit(s)or limited-energy 0 See Page 2 2 ' 7J d x / Z Q �j 9 panel,alteration,or extension. Phone:tate/ZIP: l4,8 O� G� © R Each additional inspection over allowable in any of the above ! Additional inspection(1 hr min) 66.25/hr (S03 `�q �$ ZZ Fax:( ) Investigation(1 hr min) 90.00/hr V.f f /� Industrial plant(1 hr min) 78.18/hr Email: -1//� e G7-�j� c44-L LL L' (�t/��tj-((�, �j yyJ Inspections for which no fee is �y (1(742,7 C/O!a 5 TI _ P3/ 9 specifically listed th hr min) 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lic.:9/ FRES Suprv.Electrician signature,required: v Subtotal: S(p.f 8 Print name: Ca c6 Ct.'0/c , Date: 6/457i� 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): (p,— 4 Authorized signature: TOTAL PERMIT FEE: 1///2;9 z /1,40 /�/f/// This permit application expires if a permit is not obtained within 180 Print name: /1,4 � 0,/ f p/g' At Date: f-.25— 15 days after it has beenacceptedascomplete. % // Ty` * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB Electrical Permit Application-City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: cn °i t c ail l_ Scout; Description 1 Qty I Each I Total ' a Fee for all residential systems combined: $75.00 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* >100 kva—no additional 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 specifically listed('/2 hr min 7i +C�I'CI MOM' ;n COMMERCIAL WORK ONLY: Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): 3' * Number of inspections allowed per permit. (SEE OAR 918-309-0000) 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 06/17/2015 City of Tigard Tel: 503.718.2439 Location: Inspection Date: 9195 SW SUMMERFIELD CT, TIGARD, OR, 97224 Record Type: Record ID: Residential - Electrical ELC2019-00443 Inspection Type: Inspector: 199 Electrical final David Young Result: FA I L Comments: No access for inspection, no one home. 9:30 am. No message left with inspection request. Provide access for inspections. R109 Violation Summary: Inspector Contractor