Permit (5) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2020-00059
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/30/2020
Parcel: 1 S134BD13200
Jurisdiction: Tigard
Site address: 12074 SW SUMMERBROOK LN
Project: Summerbrook, Lot 15 Subdivision: SUMMERBROOK SUBDIVISION Lot: 15
Project Description: Adding(1)branch circuit for addition of A/C.
Contractor: GARNER ELECTRIC Owner: WILLOW CREEK LAND LLC
2920 SE BROOKWOOD AVE A PO BOX 1060
HILLSBORO, OR 97123 WOODBURN, OR 97071
PHONE: 503-648-4552 PHONE: 503-213 4415
FAX: 503-642-7925
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 01/30/2020 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/30/2020 $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 9 2-001-0090. Y u
ayay obtain a py of the rules direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �C '� � „v" Permittee Signature: 'C - 27)e, /) .i
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.
A
,Electrical Permit Application
7� `�
City of Tigard Recei Date/By:ved / t30 ,IU P� C���o d`(/o'r-i/—000 5 7
13I25 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By. MIMPOA0—0 i ' .
Inspection Line: 503.639.4175 Ready Date/By: tuns: ® 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 ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION 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 ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE 1JVFORMATION AND LOCATION . ,.,` ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#:68020015 Job site address: 12074 SW Summerbrook Lane I00HP or more. ❑"A","E", 'l-z","l-3",
Cit /State/ZIP:Ti and/OR/97223 ❑Six or more residential units. occupancy.
y g ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Summerbrook 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:SW 121st Ave and Summerbrook Lane FEE SCHEDULE
Description I Qty. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision:Summerbrook Lot#: 15 Includes attached garage.
Tax map/parcel#:TBD 1,000 sq.ft.or less ). " 168.54 168.54 4
, Ea.add'I 500 sq.ft.or portion z5" 33.92 107.76 1
DESCRIPTION OF WORK Limited energy,residential
_ (with above sq.ft.) 75 00 2
, Limited energy,multi-family 75.00 2
I��1 Li J ✓ HG� fir,,,Ott/, PW i residential th above sq.ft.)
el Renewable Energy 0 See Page 2
El PROPER OWN ❑ TENANT .- Services or feeders installation,alteration,and/or relocation
Name:WEEKLY HOMES LLC 200 amps or less 100.70 2
Address: 1111 N POST OAK ROAD 201 amps to 40o amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:HOUSTON TX 77055 601 amps to 1,000 amps 301.04 2
Phone:(503)213-4415 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 I
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
Branch circuits-c new,alteration,th or extension,eer panel
APPLICANT ;`� 'CONTACT.PERSON A.Fee for branch circuits wi
Business name:David Weekley Homes above service or feeder fee, 7.42 2
each branch circuit
Contact name:Michele Schiedler B.Fee for branch circuits without
serAddress: 1905 NW 1691h Place Suite 102 branchce it feederitfee,first
14 56.18 2
branch circuit
City/State/ZIP:Beaverton/0R/97006 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)213-4415 Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: mschiedler@dwhomes.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Garner Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address:2920 SE Brookwood Ave, panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP:Hillsboro,OR 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)523-9060 Fax:(503)642-7925 Investigation(I hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:andreap@garnerelectric.com
_ Inspections for which no fee is 90.00/hr
CCB Lie.: 121159 Electrical Lic.: - 45C Suprv.Lie.: 3707S specifically listed(%:hr min)
ELECTRICAL PERMIT FEES '
Suprv. Electrician signature,required: Subtotal:
Print name: Charles Garner I i A '. -. 6/4/2019 0 Plan Review Required(25%of permit fee):
j State surcharge(12%of permit fee):
Authorized signature: . /
/S' TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Andrea Phillips Dat': 6/4/2019 days after it has been accepted as complete.
Number of inspections allowed per permit.
i a uilding\Permits\ELC PermitApp_ELR_ERE.doe Rev 06/17/2015 440-4615T(1 i/05/COM/WEB