Permit 1 _� q CITY OF TIGARD ELECTRICAL PERMIT
11 = COMMUNITY DEVELOPMENT Permit #: ELC2013 -00299
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/29/2013
Parcel: 25111 DB12100
Jurisdiction: Tigard
Site address: 15235 SW 94TH AVE
Project: Smits Subdivision: SUMMERFIELD NO.12 Lot: 648
Project Description: Panel change and (4) branch circuits in kitchen
Contractor: DISTINCT ELECTRIC, INC Owner: SMITS, TERI L
4742 LIBERTY RD STE 219 15235 SW 94TH AVE
SALEM, OR 97302 TIGARD, OR 97224
PHONE: 503 - 910 -9216 PHONE:
FAX: 503 - 763 -6880
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 05/29/2013 $100.70
Specifics:, amps or less
4 crt Branch Circuits w /Purchase 05/29/2013 $29.68
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 05/29/2013 $15.65
Electrical
Type of Const:
Occupancy Grp:
Total $146.03
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 th AR 9 s 1 -0r • • . Yo � h iay obtain a copy of the rules or direct questions to OUNC by calling 503.232.198 or 1.800.33 2.2344.
Issued By l 4 ���� / /L. d! —.I r 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 I OR OFFICE USE ONLY p9
City of Tigard
Date
/By: 5 /1 / / . 3 Permit x ° " �� /.�- � `!
-- ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Received
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G A RD Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
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 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
p 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 150 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 ",
Job no.: Job site address: 15 St-J /f /1°C- 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: - 71 y fl ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ..1 / 'I ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total
New residential single- or multi - family dwelling unit.
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
Limited energy, multi - family
,jai. 44- I CL. cit 5t, f L i. e.. L irCo -,5 s'n. e l71iot. residential (with above sq. ft.) 75.00 2
Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER ' ❑ TENANT 200 amps or less j 100.70 jOd. AI 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
ti APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee, 7 42 Z, . 6.r 2
Business name: J)'3 - f . 4-- G`f f1 Xh c each branch circuit
B. Fee for branch circuits without
Contact name: TGyy service or feeder fee, that 56.18 2
branch circuit
�
Address: 7 712- 1.: b-cft"/ g./ ,f 4 z 1 i Each add'l branch circuit 7.42 2
City/State /ZIP: IA (./ 4 , )JG"Z Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
Phone: 6d 3 )'7 /' `T Z 1 6 Fax: : CO 76 3 061-4 dwelling, service and/or feeder
Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Signor outline lighting 67.84 2
Business name: ''/ Signal circuit(s) or limited- energy See
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: ( ) \A ' 1 1 5 I ndustrial plant (1 hr min) 78.18/ hr
53 53 f (o 1 Inspections for which no fee is 90.00/ hr
CCB Lic.: 16 /or? gov Electrical Lic.: Zy - 51.3c1 Suprv. Lic.: S specifically listed (Yz hr min)
ELECTRICAL PERMIT t FEES
Suprv. Electrician signature, required:
':�1 -��`�" / 7 �� Subtotal: 13O. 3 t
....----
Print name: 005-C, , n /t/pr// Date: 5/2_9 /i Plan review (25% of permit fee):
3 State surcharge (12% of permit fee): A r. G 21
Authorized signature: TOTAL PERMIT FEE: l VC. 03
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.
1: \Building\Permits \ELC_PermitApp_ELR_ERE.doc Rev 05 /21/2013 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 systems combined ... $75.00 Description I Qty. I Pte I Total I •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to l5 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
• 25.01.to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva (fee in accordance with 552.26 2 •
❑ Heating, Ventilation and Air Conditioning OAR918- 309 -0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over25 7.42 3
❑ Vacuum Systems* >100 kva— no additional charge 0.0 3
El Other: additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly (1 hr min) 66.25/ hr
Inspections for which no fee is 90.00/ hr
specifically listed (V2 hr min)
COMMERCIAL WORK ONLY: i ELECTRICAL PERMIT FEES ., =,,? .r_!`'tr,; -1,
Fee for each, commercial system $75.00 Subtotal:
(SEE .OAR 918- 309 -0000) Plan review, if required (25% of permit fee): et
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.
El Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
❑ Instrumentation
El Intercom and Paging Systems
•
El Landscape Irrigation Control*
El Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ 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_ELR_ERE.doc Rev 05/21/2013
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
15235 SW 94TH AVE, TIGARD, OR, 97224
Residential - Electrical
115 Electrical service
05/31/2013 00:00
ELC2013-00299
PASS
Violation Summary:
Inspector Contractor