Permit CITY OF TIGARD ELECTRICAL PERMIT
Per
111 a COMMUNITY DEVELOPMENT Permit#: ELC2013-00655
T t GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/30/2013
Parcel: 2S111 DC10200
Jurisdiction: Tigard
Site address: 15575 SW OAKTREE LN
Project: Hargis Subdivision: SUMMERFIELD NO.10 Lot: 0
Project Description: (5)branch circuits for 2 bath remodel
Contractor: LIGHTING ELECTRIC LLC Owner: HARGIS,CAROLYN A
PO BOX 890 HARGIS, ROGER L
WOODBURN,OR 97071 15575 SW OAKTREE LN
TIGARD,OR 97224
PHONE: 971-338-8989 PHONE:
FAX:
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo/Purchase 10/30/2013 $85.86
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/30/2013 $10.30
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
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 gh OAR• -001-1•- . •u may obtain a�Acopyy of the rules or direct questions to OUNC by calli 1987 or 1.800.33 X4_4./j_
Issued By: �• �i�� / Permittee Signatu G% ' '�c5---
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' dig - era _ Date:
u
LICENSE NO.
Call 603.639.4175 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 C ,�I p .. FF lC usl.O
FoR Nl,YY
Cl� of Tigard lU liL, `?r L,;.... Received
Date/B : /o �� /3 Permit No.:
Ili cc-,4�/.3 D0t!2SS
V 13125 SW Hall Blvd.,Tigard,OR 97223^ Plan Review
C Phone: 503.718.2439 Fax: 503.598.140T 3 ® 2013 Date/B ; Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: furls: ® See Page 2 for
T I G A R D Internet: www.ti g ar d-0r.g ov CITY OF rIGARD Notified/Method: Supplemental Information
TYPE OF-vVO"1"'V p?,"I'OQOI1r PLAN REVIEW
❑New construction ddition/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
1-and 2-family dwelling ❑Cornmercialindustrial ❑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: l j575 Sw O1tk9 II,-, Sinop or more. on parks.
❑Six or more residential units. ❑Recreational vehicle arks.
�...
City/State/ZIP: j t' j Q ❑Health-care facilities. ❑t 00 upply
volts voltage for more than
1` ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: 11R,,,,,IS. ❑Service or feeder 600 amps or more.
_J FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total 1 • '
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 75.00 2
)(z A 0.h PC� I !�0 n Q' residential(with above sq.ft.)
/`� 12' t� ' Renewable Energy ❑ See Page 2
• . 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: Rot)er6 'kite . . 401 amps to 600 amps 200.34 2
Address: / . -75 51../ Owl fr l° 601 amps to 1,000 amps 301.04 2
'`�'� A Over 1,000 amps or volts 552.26 2
City/State/ZIP: I I-_Id t/U) vl7 14. Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
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
❑ APPLICANT I 11 CONTACT PERSON , A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: Q each branch circuit
�� '�-G B.Fee for branch circuits without
Contact name: /1 j l 7 1..h3 service or feeder fee,first
branch circuit 56.18 2
Address: pc) Ad X //46 Each add'l branch circuit y 7.42 2
City/State/ZIP: Ake l..at,.t: / 9:7325-
�6t 25- Each manufactured a or(service modular
feeder not included)
Each manufactured or modular 67.84 2
Phone: ) ( ' j a 2.5t � Fax: :( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: Ti-,flee t of ,D>/et.t 6e• ,) Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:G' 4r Ei L! J ll L+ Signal circuit(s)or limited-energy See
i �oL� t°C ri l�. LL panel,alteration,or extension. Page 2 2
Address: (�Q / o.- 6 qc, Each additional inspection over allowable in any of the above
City/State/ZIPr, ' /6 �, // G� ^� / Additional inspection(1 hr min) 66.25/hr
WO c /, h 0/� / 7°7 l Investigation(1 hr min) 66.25/hr
Phone:(,?/) 3i —(-q rq. Fax:( ) Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.it 6 Z q Electrical Li .: C 1 OL Suprv.Lic.: 535-5 specifically listed(/z hr min) 90.00/hr
D C( ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: f i S.(f.N Subtotal: ?5",860
Print name: j, ,e h Date: Plan review(25%of permit fee):
ohm Nri, (/�%� State surcharge(12%of permit fee): /C'.3OO
Authorized signature: , —,:=r - •. • TOTAL PERMIT FEE: 96. /la
•
� j L to yo This permit application expires if a permit is not obtained within 180
Print name: .�-r 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/OS/COM/WEB
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15575 SW OAKTREE LN, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
2013-11-21 (null)
ELC2013-00655
PASS - No C of O
Violation Summary:
Inspector Contractor