Permit CITY OF TIGARD ELECTRICAL PERMIT
1 111 1
a. COMMUNITY DEVELOPMENT Permit #: ELC2013-00187
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/26/2013
Parcel: 2S112CA03400
Jurisdiction: Tigard
Site address: 15270 SW 79TH AVE
Project: Trevor Subdivision: DURHAM ACRES Lot: 30
Project Description: (13) branch circuits
Contractor: OWNER Owner: BRETT TREVOR
15270 SW 79TH AVE
TIGARD, OR 97224
PHONE:
PHONE: 541 - 350 -0383
FAX:
FEES
Quantity Description Date Amount ,
13 crt Branch Circuits wo /Purchase 03/26/2013 $145.22
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/26/2013 $17.43
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $162.65
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 • • 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 1 ! ∎11.a� . _ ems./ i Permittee Signature:
aLI 4-PPLie4-nO •
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 RECEIVE , FOR OFFICE USE ONLY
City of Tigard Received : 3/_ 3 Sr Permit No.: 6,-- c?013 -
" 13125 SW Hall Blvd., Tigard, OR 97223 MAR 2 6 2013 Plan Review Other Permit:
C • Phone: 503.718.2439 Fax: 503.598.1960 Date/B :
1' I G A R D
Inspection Line: 503.639.4175 Date Ready/By: t ® See Page 2 for
p CITY OF TIGARD y o� ''y° i OO Supplemental Information
Internet: www.tigard- or.gov Notified/Method:
TYPE OF W ELDING DIVISION PLAN REVIEW
El New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ 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 ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® I - 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
to 100HP or more. occupancy.
Job no.: Job site address: 15270 SW 79
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Thurston and 79th Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Add bathroom fan, electrical outlet for gas fireplace, and additional branch residential (with above sq. ft.) - -
Services or feeders installation, alteration, and/or relocation
circuits in garage for furnace, hot water heater, etc. 200 amps or less 100.70 ■ 2
El PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Brett Trevor 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 15270 SW 79 Ave Over 1,000 amps or volts 552.26 2
City/State /ZIP: Tigard, OR 97224 • Temporary services or feeders installation, alteration, and/or
relocation
Phone: (541)350 -0383 Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I ® CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: -
B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: Same as owner branch circuit
Each add'l branch circuit 12 7.42 89.04 2
Address: Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Homeowner install panel, alteration, or extension. Page 2 2
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 (l hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (V2 hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: o Subtotal: 145.22
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): 17.43
TOTAL PERMIT FEE: 162.65
Authorized signature: A /1 A1
• This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
��
Print name: ;7 •i.,� ID r Q t T for Date: �'D — 1 3 • Number of inspections allowed per permit.
'I: \ Building \Permits'ELC- PermitApp.doc 07/01/10 440- 4615T(Il /05 /COM/WEB
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
15270 SW 79TH AVE, TIGARD, OR, 97224
Residential - Electrical
120 Electrical rough-in
03/27/2013 00:00
ELC2013-00187
PASS
Violation Summary:
Inspector Contractor