Permit •
CITY OF TIGARD j • ELECTRICAL PERMIT
•
COMMUNITY DEVELOPMENT / Permit #: ELC2013 00357
Date Issued: 06/27/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 � , Parcel: 1 S134ACO2616
Jurisdiction: Tigard
Site address: 11255 SW WILLOW WOOD CT
Project: Coleman Subdivision: ENGLEWOOD NO.3 Lot: 173
Project Description: (3) branch circuits for remodel. 7/1/13, add (2) additional branch circuits.
Contractor: OWNER Owner: COLEMAN, WALLACE C & SUSAN L
COLEMAN, ALEX 11255 SW WILLOW WOOD CT
11255 SW WILLOW WOOD CT TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 541 - 513 -8970 PHONE: 541 - 513 -8920
FAX:
FEES
Quantity Description Date • Amount
•
Specifics: 3 crt Branch Circuits wo /Purchase 06/27/2013 $71.02
Service or Feeder
• 1 ea 12% State Surcharge - 06/27/2013 $8.52
Type of Use: SF Electrical
Class of Work: ALT 2 crt Branch Circuits w /Purchase 07/01/2013 $14.84
Service or Feeder
Type of Const: 0 ea 12% State Surcharge - 07/01/2013 $1.78
Occupancy Grp: Electrical
Total $96.16
Required Items and Reports (Conditions)
This permit is ' ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done i• accordance w • 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. • ENTION: Oregon w •q you to follow the rules adopted by the Oregon Utility Notifiiipa, Center. . Those rules are set forth in OAR
952 -01 -0010 through OAR 952-001-00 •u may obtain a copy of the rules or direct questions to OUNC by ca ' 3.232.19 or 1.800.332.2344.
Iss . =d By:
y: �.`. Permittee Signatur .
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.
CITY OF TIGARD ELECTRICAL PERMIT
a, COMMUNITY DEVELOPMENT Permit #: ELC2013 -00357
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/27/2013
Parcel: 1 S134ACO2616
Jurisdiction: Tigard
Site address: 11255 SW WILLOW WOOD CT
Project: Coleman Subdivision: ENGLEWOOD NO.3 Lot: 173
Project Description: (3) branch circuits for remodel
Contractor: OWNER Owner: COLEMAN, WALLACE C & SUSAN L
COLEMAN, ALEX 11255 SW WILLOW WOOD CT
11255 SW WILLOW WOOD CT TIGARD, OR 97223
TIGARD, OR 97223
PHONE. 541 - 513 -8970 PHONE: 541 - 513 -8920
FAX
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 06/27/2013 $71 02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/27/2013 $8 52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79 54
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 ATTENTIO • regon law requires you to follow the rules adopted by the Oregon Utility Notification Ce Those rules a set forth in OAR
952- 001 -0010 rough 0 952 -00 r 0 •' You may obtain a copy of the rules or direct questions to OUNC by calling 503 23 87 r 1.800.332 23
Issued By: ' / t / Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on prope ; ow • hich is not intende• or : e, lease or rent 2
OWNER'S SIGNATURE _ �L `m Date: h �7//
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 FOR OFFICE USE ONLY
Received A Permit No
City of Tigard y � Date/13y U' ,,,,27 � / eLL�o�d/3'�' 3s7
;� v 13125 SW Hall Blvd., Tigard,OR 9722ECE� ]
Plan
Date/By. Review Other Permit.
Phone' 503.718.2439 Fax: 503.598.19 0 °J Date/By
I' I G A t. a Inspection Line: 503.639.4175 I 2 Date Ready/By Juno ® See Page 2 for
Internet: www tlgard- or.gov J �.; N 2 7 2013 Notified/Method Supplemental Information
TYPE OF W 'PLAN REVIEW ,
OFTIGARD
El New construction XAddition/alteB check all that apply (submit 2 sets of plans w /items checked below).
�ISION ❑ 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
it it1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations buildings
El 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 ", "I - ", "1 - ",
Job no.: Job site address: I S S� 0,)% l t
I vw (-� W S or more occupancy
❑Six ix or or more residential units ❑ Recreational vehicle parks
City /State /ZIP: T i y / 0 jZ / q - ❑ Health - care facilities ❑ Supply voltage for more than
x`11 / I -)d-� ❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: fColve— ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: 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
Ea add'I 500 sq. ft. or portion 33 92 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq ) 75 00 2
■
ft
0 \Z-- ) 1^n ICS 4. �' i �� Limnedenergy, muabfvesq 7500 2
V 1 � r residential (with above sq ft.)
c---, Re newable Energy ❑ See Page 2
I ( c > v ( � "" c,lpd. l - ()V\ Services or feeders installation, alteration, and/or relocation
PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133 56 2
Name: N\ (_,,,, C 6 QVv 1 401 amps to 600 amps 200 34 2
Address: 1 Cz S S S kk) 1 1 l 6 1,6 \ jJo 1 CA ■ 601 amps to 1,000 amps 301 04 2
ty I i 1 O f 1 ^ ) � Over ora amps sei or 5 , a te 2
City/State/ZIP: C� / K Temporary services or feeders installation, alteration, and /or
Phone: (511 ) 5 3 relocation ZC� Fax: ( ) 200 amps or less 59.36 1
Owner installation: T h i s - . Ilation is being m on property that I own which is not 201 amps to 400 amps 125 08 2
intended for sale, leas =, rent s r exchange, ac rd• g to ORS 447, 449, 67 d 701 401 amps to 599 amps 168 54 2
Owner signature: _ o - Date: ? 7 / 3 Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A Fee for branch circuits with
above service or feeder fee, 7 42 2
Business name: each branch circuit
B Fee for branch circuits without /
Contact name: service or feeder fee, first 1 56 18 54 -/ C 2
branch circuit
Address: Each add'I branch circuit ,2. 7 42 P./ . 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 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: ( ) Industrial plant (1 hr min) 78.18 / hr
Inspections for which no fee is 90 00/ hr
CCB Lie.: Electrical Lic.: Suprv. Lic.: specifically listed (%3 hr min)
ELECTRICAL PERMIT ■ FEES -
Suprv. Electrician signature, required: Subtotal 7/ .0 7 "
Print name: Date: Plan review (25% of permit fee): ..-----■
State surcharge (12% of permit fee): Q , S
Authorized signature: TOTAL PERMIT FEE: - 7
This permit application expires if a permit is not obtained within 18d
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit
I i Building \Permits\ELC_PernuiApp_ELR_ERE doc Rev 05/21/2013 4404615T(r l /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 Qtr. 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
❑ 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
OAR 918- 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
❑ Each 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 (% 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
❑ Audio and Stereo Systems days after it has been accepted as complete.
Number of inspections allowed per permit.
❑ 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 \ BwldmgTermits \ELC_PermitApp_ELR_ERE doc Rev 05/21/2013
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing per mits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
A of, (?,okvtA\
Print Nam Permit Applicant
n //3
Signature of Permit Applicant Date
Permit #: kHAo / 3- 00 01 /l E Le2- o'3 35-7 •r,4111k•
Address: //a 6S & gL3 /LL ) 4 � Cr 4 ? ti . `..�
------- a4-.2b, 0 97? � �c;�i.
^^I-P,�- to/7/0 ra
Issued byf�� D ate:
This Copy for Permit Offices
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
11255 SW WILLOW WOOD CT, TIGARD, OR,
97223
Residential - Electrical
120 Electrical rough-in
06/28/2013 00:00
ELC2013-00357
FAIL
1. Provide smoke detectors and carbon monoxide detector
2. Provide 2 /20 amp circuits to kitchen and 1 for microwave
3. Grounds to be pigtailed
Violation Summary:
Inspector Contractor