Permit q CITY OF TIGARD ELECTRICAL PERMIT
ip
a COMMUNITY DEVELOPMENT Permit #: ELC2013 00035
'TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/17/2013
Parcel: 1 S 134 BD06700
Jurisdiction: Tigard
Site address: 11655 SW SPRINGWOOD DR
Project: Anderson Subdivision: ENGLEWOOD NO.2 Lot: 155
Project Description: (1) branch circuit for bathroom remodel
Contractor: OWNER Owner: ANDERSON, MONIQUE
11655 SW SPRINGWOOD DR
TIGARD, OR 97223
PHONE:
PHONE: 703 - 629 -4166
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 01/17/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/17/2013 $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 95 - 1 01 -0090 You may o , tain a copy of the rules or direct questions to OUNC by calling 503.232.1987
or
87 or 1.800.332.2344. /
Issued By: �+' �-C� A
Dl /''
Permittee p�'e 1 r / £24_
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.
p.1
Electrical Permit ApplicatiRi ECEI M ED FOR OFFICE USE ONL1'
I /7 / 3 Pam No -ea) 3
City of Tigard Received �� � � �� /3 -
13125 SW Hall Blvd., Tigard, OR 97218r't N 1 5 2013 Plan Review
Phone: 503.718.2439 Fax: 503.59 Dateav': OtherPemil:
l' 1 G.A R D inspection Line: 503.639.4175 CITY OFF TIGARD Date Ready/By. rail 0 See Page 2 for
Internet: wtivw.tigard- or.gov gUll.DtNG DIVISION! Notified/method: ' ' co Supplemental Information
TYPE OF WORK I-- PLAN REVIEW j
El New construction Add ition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 40D 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 15O volts or Cl Floating buildings.
less to greond, or exceeds 14,000 ❑ Commercial -use agricultural
.1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other. ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ ".A ", "E "I - 2", "1 - ",
, n �. 10011P or more, occupancy.
Job no.: Job site address: 1 W�5 1� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: t Dar l 91a- ca
a- a ❑ Health-care facilities. ❑ Supply voltage for more than
� � ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt.no.: I Project name: n,,, 041 'n,� rd -A- ❑Serveoe or feeder 600 amps ormore.
' 'r���t`"'' FEE SCHEDULE
Cross street/directions to job site: Otpioo I otr• I Fee. I Tall I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1.000 sq. ft. or less 168.54 ] 4
Ea. add'l 500 sq. ft. or portion 33.92 L
Tax map/parcel no.: Limited energy, residential ,
75.00 2
DESCRIPTION OF WORK (with above sq. fl.)
. 1 n ! ( r^ ft , ( Limited energy, multi-family aabove q. 75.00 2
MAO{ L l.: T ` C + l A residential (with above sq. ft)
Services or feeders installation. alteration, and/or relocation
200 amps or less 100 70 2
PROPERTY OWNER ❑TENANT 201 amps to 400 amps _ 133.56 2
4W amps to 600 amps 200.34 2
Name: VkbY\ (Svc_ 601 amps to 1,000 amps 301.04 2
Address: (I () Q.) 4 '9 ( - 1 Aiettt Dr, Over 1,000 amps or volts 552.26 2
`�s� Temporary services or feeders installation, alteration, and/or
City / Slate/ZIP: 1 \ �(/l t
1rd t -- '' -- 7.›..,1-, - relocation
Phone: ( 7 ) (p a 0 ----L{ [ C (p • : ( ) 200 amps or less 59.36 1
Owner installation: This installation is ode on property that I own which is not 4 01 amps to 400 amps 125. 2
according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 r 2
intended for sale. lease rent, or each. i ! g _ / 2 Branch circuits- new, alteration, or extension, . er i anel
Owner signature: �i i Date: I I` ! J A Fee for branch circuits with
!
above service or feeder fee,
X APPLICANT I ❑ CONTACT PERSON 7 42 2
each branch circuit
0
Business name: Fee for feeder . Fee for branch circuits first
without 1111196
2
se or or fe fc rst
Contact name: branch circuit
Each add'I branch circuit 774^ 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State/ZIP: dwelling, service and/or feeder
Reconnect aaty 67.84 2
Phone: ( ) Fax: : ( ) Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR ' Signal circuits) or limited- energy
panel, alteration, or extension_ Page 2 2 '
Business name:
Each additional inspection over allowable in any of the above
Address: Additional inspection (I. hr min) 66.25 / hr
Investigation (1 hr min) 66.25/ hr '
City /State /ZIP:
Industrial plant ( 1 hr min) 73.18; hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
90.00/ hr
specifically ly listed (:7 hr min)
CCB Lic.: I Electrical Lie.: Suprv. Lie.: ELECTRICAL PERMIT FEES
Subtotal:
Suprv. ctr an signature, Elici required:
— Plan review (25% of permit fee):
Print name: Dale: Stole surcharge (12% of permit fee) :t ,C1212 67
TOTAL PERMIT FEE: ! Z
Authorized signature: This permit application expires if a permit is not named within 180
days after it has been accepted as complete.
Print name: Date: a I`nmba of inspections allowed per permit.
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11655 SW SPRINGWOOD DR, TIGARD, OR,
97223
Residential - Electrical
199 Electrical final
02/25/2013 00:00
ELC2013-00035
FAIL
Open ground on bathroom gfci
Violation Summary:
Inspector Contractor