Permit (84) CITY OF TIGARD ELECTRICAL PERMIT
.7 COMMUNITY DEVELOPMENT Permit#: ELC2019-00564
Tf((.A.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/28/2019
Parcel: 2S102AB00601
Jurisdiction: Tigard
Site address: 12075 SW LINCOLN AVE
Project: RUGGIERO Subdivision:RTH TIGARDVILLE ADDITION,AMENC Lot: 63
Project Description: (1)branch circuit for tankless water heater.
Contractor: OWNER Owner: RUGGIERO, RYAN C&NICOLE S
12075 SW LINCOLN AVE
PORTLAND, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 08/27/2019 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/27/2019 $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, 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 ma obtai - - ..f the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344
Issued By: / e..Lrd �� 4'!� 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
x ;
City of Tigard .'`,, Received
DateB : , 7 I� /
ENI
13125 SW Hall Blvd.,Tigard,OR 97223 I y i -
III - Phone: 503.718.2439 Fax: 503.598.196k 2 '' 0,I�, Plan Review Related Permit it: / ''
,. F DateB : p4iP
TIGARI? Inspection Line: 503,639.4175 ReadyDateBy: 10 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: 111M1 Supplemental Information
-Adiit-i ' 414 ',;`.4f2- ,`t' 'F.tlPt- it..i,4',7..' f4, , ,' gal -- lin,,r 1 -"_ m•' .aa
❑New construction M 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 ❑Other:
where the available fault current 0 Marinas and boatyards.
l' uH ;: c A.T;EGORY OF CONSTRUCsTION 4'?:4„,-c,,,-, exceeds 10,000 amps at 150 volts or 0 Floating buildings.
RI 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to round,or exceeds 14,000 0 Commercial-use agricultural
❑Multi-family 0amps for all other installations. buildings.
Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or
-411° uJOB'-STE NFORTION AND LOCATIOI, � s�! El Emergency system. larger separately derived
�1+ �
o Addition of new motor load of system
Job#: Job site address. 100HP or more. ❑"A", E","1-2","1-3",
City/State/ZIP: t
❑Six or more residential units. occupancy.
IRecreational vehicle arks.
0Health-care facilities. 0 P
Suite/bldg./apt.#: Project name: 4
t 0 Hazardous locations. 0 Supply voltage for more than
I.
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: „ ..- i ,-,10110401101111'05t- ,i" JIw I tt� `:
p-toy 'FEE SCFI Qt :e i��plT h dta
Description I Qty, I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: &3 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: `,4!07-40.00401 Ea.add'I 500 sq.ft.or portion 33.92 1
' 41114t, DESGR TION_OF WORKOMii ii ii' Limited energy,residential
I Y1 114: 6^, @-.f` ( ;f.)ivv, t 4 Ulit, :111°. fel_4. (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
rot( vt "vat "{ • " " residential(with above sq.ft.)
ilk -:: [ PROPERTY OWN1;ti iI 'ISTIMM 0 TENANT qol t Renewable Energy 0 See Page 2
11u" � - - Services or feeders installation,alteration,and/or relocation
Name: /rim— 200 amps or less 100.70 2
Address: till 5, iii ^tro tp. 201 amps to 400 amps 133.56 2
.-{-- 401 amps to 600 amps 200.34 2
City/State/ZIP: i 1 111/7.'5 601 amps to 1,000 amps 301,04 2
Phone:( ?41 ) '7,`i 0 +t'); Fax:( ) Over 1,000 amps or volts 552.26 2
t ., Temporary services or feeders installation,alteration,and/or
Email: r&Y-v 4 , 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: 0 -7-1 ..i i 401 amps to 599 amps 168.54 2
1111W`
= *�0 i - �� q r�sv-;, Branch circuits—new,alteration,or extension,per panel
iii -.'' ,API ICANT ...:..1,1,0007"—'
s„�:uid ids t i�GONTAGT PERSi)N,. ��I��II
A.Fce'for breach circuits ivitl�
Business name: above service or feeder fee,
each branch circuit
7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 (�i, 2
branch circuit
City/State/ZIP:
Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone: ( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder
Email: 67.84 2
Reconnect only 67,84 2
_,',. . -- ---S;':-*-4141 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
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
90.00/hr
CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed('/2 hr min)
n6ad . a EI.ECTRIOAI PER11l MES
Suprv.Electrician signature,required: Subtotal: 4, ,
Print name: I Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 7
Authorized signature: TOTAL PERMIT FEE: -'7).
This permit application expires if a permit is not o tamed within 180
Print name: ` f 'y(2. 9, Date: (y .° ' ./1 days after It has been accepted as complete.
r f
* Number of inspections allowed per permit.
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
12075 SW LINCOLN AVE, TIGARD, OR, 97223 August 30, 2019 at
10:33:27 AM
Record Type: Record ID:
Residential - Electrical ELC2019-00564
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor