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Permit CITY OF TIGARD ELECTRICAL PERMIT 1111 COMMUNITY DEVELOPMENT Permit#: ELC2013-00214 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.243�� I Date Issued: 04/11/2013 '7'44 Parcel: 1 S135DA04400 Jurisdiction: Tigard Site address: 9055 SW NORTH DAKOTA ST ' Project: Mansfield Subdivision: 1997-057 PARTITION PLAT Lot: 1 Project Description: Upgrade electrical panel to 200 amp. 5/4/15,reprinted to add(27)additional branch circuits. Contractor: OWNER Owner: MANSFIELD, RYAN W MANSFIELD,VANESSA L 9055 SW N DAKOTA ST TIGARD, OR 97223 PHONE: PHONE: 503-349-3701 FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders-200 04/11/2013 $100.70 Specifics: amps or less 10 crt Branch Circuits w/Purchase 04/11/2013 $74.20 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 04/11/2013 $20.99 Electrical Type of Const: 27 crt Branch Circuits w/Purchase 05/04/2015 $200.34 Occupancy Grp: Service or Feeder 24 12%State Surcharge- 05/04/2015 $24.04 Electrical(manual) Total $420.27 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 don- ' -•re. -- with approv-• plans. This permit will expire if work is not started within 180 days of issuance, or if wor suspended for more the 180 da ATTENTION: Oreg•• la req ires you to follow the rules adopted by the Oregon Utility Notification Center rules are set forth in OAR 9.2-001-0010 through OAR 95.'01-009'/Y•' may obtain a copy of the rules or direct questions to OUNC by calling 32.19,• :1I• •.2344' i Issued By: ! / �I Permittee Signature: J- _��__� /, r ' OWNER INSTALLATION ONLY The installation is being made on pr y I o Ta tended for sale,lease or rent. OWNER'S SIGNATURE _ ■_-!�� Date. .;p7 I 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 Applicati FOR OFFICE USE ONLY �ECEg�E[� �/n City of Tigard Date/13e: 'SAME' Permit 4: C�/�80/ —#r I 1111 - • 13125 SW HaII Blvd.,Tigard,OR 9722 , i 4 2015 Plan Review Phone: 503.718.2439 Fax: 503.598.1'P t Date/13 : Related Permit 4: Inspection Line: 503.639.4175 Ready Date/By: Juris: ® See Page 2 for TIGARD Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information TYPE O VI 'EW ' ❑New construction ❑Addition/alteration/replacement Please check all that apply(submit a sets of plans w/items checked): El Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories. where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. ❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑ Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑installation of 150 KVA or trgartunn - a t ■t _ Y e ► t'rt AND LOCATION, - - - ['Emergency system. larger separately derived Job#: Job site address: ` ❑Addition of new motor load of system. �� O4C.� v frtr# //j ikj4j-A-• I00HP or more. ❑«A» «E„ «1_2»,«1_3», Ci /State/ZIP: ❑Six or more residential units. occupancy. ty ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: I Project name: )..-{ - ri c L D ❑Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: Description Qty. Each Total . 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 Limited energy,residential 75.00 2 n Q (with above sq.ft.) �� �7 4 l t0-✓� D-+�-r Limited energy,multi-family e „, .'-�'�� residential(with above sq.ft.) 75.00 2 "` ` Renewable Energy ❑ See Page 2 �n v Services or feeders installation,alteration,and/or relocation Name: ��„ ► ��t\S Lo 200 amps or less 100.70 2 Address: v 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installati t 1:Th.• .ta ati, ;r '1'1 mad- on pros-• that I own which is not 200 amps or less 59.36 1 1 intended for sal=,l;. e,r or e, .cc• 1 m". .. i'S 447,449,670,and 701. 201 amps to 400 amps 125.08 2 401 amps signature' � �to 599 amps 168.54 2� Date: p Branch circuits-new,alteration,or extension,per panel _ A.Fee for branch circuits with Business name: above service or feeder fee, each branch circuit 742 2 Contact name: B.Fee for branch circuits without Address: service or feeder fee,first 56.18 2 branch circuit City/State/ZIP: Each add'l branch circuit 7 7.42 .3f! 2 Miscellaneous(service or feeder not included) Phone:( ) I Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67.84 2 Address: pannel,alteration o ,or extension. ❑ 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) 66.25/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: ( Electrical Lic.: Suprv.Lic.: s.-cificall listed 'Ahrmin Suprv.Electrician signature,required: Subtotal: „„Zp. 35' Print name: Date: ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): al4.BSL Authorized signature: TOTAL PERMIT FEE: acre/,3$' This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\F.LC_PermitApp ELR_ERE.doc Rev 04/21/2014 440-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Fee for all residential s 3' Renewable combined: $75.00 R O° Qty. Each I Total I enewwable 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 552.26 2 with OAR 918-309-0040) _ ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 n Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in anyof the above: ❑ Other: Each additional inspection is 66.25/hr charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed %hrmin COMMICOAMMIXONOZ Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 • Number of ins (SEE OAR 918-309-0000) pcetions allowed per permit. 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 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 04/21/2014 q CITY OF TIGARD ELECTRICAL PERMIT = COMMUNITY DEVELOPMENT Permit #: ELC2013 -00214 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/11/2013 Parcel: 1 S135DA04400 Jurisdiction: Tigard Site address: 9055 SW NORTH DAKOTA ST Project: Mansfield Subdivision: 1997 -057 PARTITION PLAT Lot: 1 Project Description: Upgrade electrical panel to 200 amp Contractor: OWNER Owner: MANSFIELD, RYAN W MANSFIELD, VANESSA L 9055 SW N DAKOTA ST TIGARD, OR 97223 PHONE: PHONE: 503 - 349 -3701 FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 04/11/2013 $100.70 Specifics: amps or less 10 crt Branch Circuits w /Purchase 04 /11/2013 $74.20 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12% State Surcharge - 04/11/2013 $20.99 Electrical Type of Const: Occupancy Grp: Total $195.89 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 actor• _ • - 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. ATTE ' •N: Oregon .. req • o • follow the rules adopted by the Oregon Utility Notification Center. Those s are set forth in OAR 952 - 001 -00 • through OAR 952 -00 r : •0. You btain a copy of the rules •r direct questions to OUNC by calling 503.232.198 1.80. 3 44. Issued y: I . /4/ : Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on operty • •• his • inter •ed for sale, lease or rent. !/ OWNER'S SIGNATURE ��� , Date: r ��/�3 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 F(>IZ ()HALL I SE 0 y1.1 III City of Tigard RECEIVED Re eiv • S/ Permit No.: Z a i �� „2/ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.1 Date/By: Other Permit: AP 1 1 2013 I l G A R n Inspection Line: 503.639.4175 Date Ready/By: Juris: 10 See Page 2 for Internet: www.tigard - or.gov CITY OFTiGARD Notified/Method: Supplemental Information TYPE Ori !RING' DN!SION PLAN REVIEW Please check all that apply (submit 2 sets of plans w /items checked below): ❑ New construction ® Addition/alteration/replacement ❑ 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 13 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 JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "I - ", GI G /� 100HP or more. occupancy. Job no.: Job site address: 1 055 6....5 ! r o p�"`D (a ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: - 1 - 1: C rt�l , V T q �- ZZ3 ❑ Health -care facilities. ❑ Supply voltage for more than v ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: g q eQ ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: No r - 4 .. V, O got" .4 A/ (_ Description I Qty. I Fee. I Total l V New residential single- or multi - family dwelling unit. �, ` 140.{ r� `'j . Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'l 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 rr 77 Limited energy, multi- family p v-Gd�} l.� 9 Q a't / n r 1 < cam- .)e-sr- 1 <R . i-G t 4- residential (with above sq. ft.) 75.00 2 V U Renewable Energy ❑ See Page 2 Services or feeders installation, alteration, and/or relocation PROPERTY OWNER ❑ TENANT 200 amps or less 'l 100.70 ��. 70 2 201 amps to 400 amps 133.56 2 Name: V G h / I ) c...-1 S �t Q,� 401 amps to 600 amps 200.34 2 Address: GlOSS Sc.., Nor4L, y-ot 601 amps to 1,000 amps 301.04 2 n Over 1,000 amps or volts 552.26 2 City/State /ZIP: –17500, ,Q ' C i 4 Z Z 3 Temporary services or feeders installation, alteration, and /or Phone: (503) 34 e . 31.01 Fax: ( ) relocation 200 amps or less 59.36 1 Owner installation: This installation • being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, leas or e, according to ORS 447, 449, 670, d 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: ">< 4/ 3 Branch circuits – new, alteration, or extension, per panel ❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with ( above service or feeder fee, 10 7 42 7 l ' ,24 2 Business name: each branch circuit B. Fee for branch circuits without Contact name: service or feeder fee, first 56.18 2 branch circuit Address: Each add'I branch circuit 7.42 2 City/State /ZIP: Miscellaneous (service or feeder not included) Each manufactured or modular 67.84 2 Phone: ( ) Fax: : ( ) dwelling, service and/or feeder Reconnect only 67.84 2 E - mail: Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: Signal circuit(s) or limited - energy panel, alteration, or extension. Page 2 2 Address: Each additional inspection over allowable in any of the above Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: Investigation (1 hr min) 66.25/ hr Phone: ( ) Fax: ( ) Industrial plant (1 hr min) 78.18/ hr Inspections for which no fee is 90.00 / hr CCB Lic.: Electrical Lic.: Suprv. Lic.: specifically listed (Y2 hr min) ELECTRICAL PERMIT Suprv. Electrician signature, required: Subtotal: / 74/ 96 Print name: Date: Plan review (25% of permit fee): — State surcharge (12% of permit fee): OZO. 99 Authorized signature: TOTAL PERMIT FEE: / 9 5 Print name: Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. * Number of inspections allowed per permit. I:\ Building\ Permits \ELC_PermitApp_040913.doc 440- 4615T(i 1/05 /COM/WEB Electrical Permit Application — City of Tigard Page 2 — Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE • Fee for all residential systems combined ... $75.00 Description I Qty. I Fee I Total I Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 El 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 El Garage Door Opener* >100 kva (fee in accordance with OAR 918- 309 -0040) 552.26 2 El Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over25 7.42 3 ❑ Vacuum Systems* >100 kva— no additional charge 0.0 3 Each additional inspection over allowable in any of the above: El Other: Each additional inspection is 66.25/ hr 1 charged at an hourly (I hr min) Inspections for which no fee is 90.00/ hr specifically listed (V2 hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system $75.00 Subtotal: (SEE OAR 918- 309 -0000) Plan review, if required (25% of permit fee): State surcharge (12% of permit fee): Check Type of Work Involved: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 El Audio and Stereo Systems days after it has been accepted as complete. • Number of inspections allowed per permit. ❑ Boiler Controls ❑ Clock Systems El Data Telecommunication Installation ❑ Fire Alarm Installation El HVAC ❑ Instrumentation ❑ Intercom and Paging Systems El Landscape Irrigation Control* El Medical El Nurse Calls ❑ Outdoor Landscape Lighting* El Protective Signaling El Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:Building\Permits\ELC PermitApp_040913.doc