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Permit I , � CITY OF TIGARD ELECTRICAL PERMIT II s COMMUNITY DEVELOPMENT Permit #: ELC2013 00737 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/11/2013 Parcel: 2S112BCO5800 Jurisdiction: Tigard Site address: 8420 SW LA MANCHA CT Project: Fannie Mae Subdivision: LA MANCHA ESTATES Lot: 11 Project Description: Electrical reconnect only Contractor: Owner: FANNIE MAE 8420 SW LA MANCHA CT TIGARD, OR 97224 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 1 ea Reconnect Only 12/11/2013 $67.84 Specifics: 1 ea 12% State Surcharge - 12/11/2013 $8.14 Electrical Type of Use: SF Class of Work: OTR Type of Const: Occupancy Grp: Total $75.98 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: O I requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throu OAR 952 -001 0090 u m obtain a copy of the rules or direct questions to OUNC by callin. _e_ . 2.1987 or 1.800.332.2344. !�/ Issued By: Permittee Signature: - _ � ✓ _ i 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 FOR OFFICE USE ONLY g DEC EIVED D ate / BBy At / //, 3 L eke /3-i 7E9 Cl of Tigard Received Permit No.: " 13125 SW Hall Blvd., Tigard, OR 972 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard- or.gov DEC 10 2013 Notified/Method: Supplemental Information F YI'l: OF WORK PLAN REVIEW ❑ New construction ❑ Addition/alterafio Please check all that apply'(submit 2 sets of plans w /items checked below): � j� 15� O1\ ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition Other: E(e '(`#''( L C ), A no. L — 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 Ell - 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: C 11'' < 1 . I I CA- 10o1-IP or more. occupancy. C1 N �� } )Y V Li 1y � l�Q ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: 7 c)(1._ q-i72 -/ 113 Health-care facilities. El Supply voltage for more than "/ El Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: c,41'A)101 tiA-E__ ❑ 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'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 EI e L"� ((Ci � C 0 (Lad- . Q C J' residential (with above sq. ft.) Renewable Energy ❑ See Page 2 _�—p'1 - X? (.4 (51" Services or feeders installation, alteration, and/or relocation ❑ PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2 201 amps to 400 amps 133.56 2 Name: Cct r-) n( a , &Q-. 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 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, .er panel ❑ APPLICANT XL CONTACT PERSON A. Fee for branch circuits with 1 /7 above service or feeder fee, Business name: �rksh l re_ � T L jai N u) l.&cJ / L at , each branch circuit 7.42 2 Nu) `� B. Fee for branch circuits without Contact name: Lajo V(A_ a ITY/ 62.4i service or feeder fee, first branch circuit 56.18 2 Address: 33 ( E CoLe.,till G a_ Ave. *I U Each add'l branch circuit 7.42 2 City /State /ZIP: US (D Miscellaneous (service or feeder not included) Se (Q 9 ( -7 Each manufactured or modular Phone: (5 � Fax: G - 2. dwelling, service and/or feeder 67.84 2 1 �� 0 p /81 - � �� ( / C �) x `� Reconnect only ! �� a 67.84 c, 2 E -mail: a J(� ) C D . � "r b Pay I fl � cAi , (�1 ' Pump or irrigation circle + 67.84 � 2 CONTItACFOR 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 (l hr min) 78.18 / hr Inspections for which no fee is 90.00/ hr CCB Lie.: Electrical Lie.: Suprv. Lic.: specifically listed (%S hr min) ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: L-7, gU Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): S t , Authorized signatur TOTAL PERMIT FEE: '75. CA This permit application expires if a permit is not obtained within 180 Print name: D ,ca a t(4 vl A Date: 1, 2-3- 1- days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Pennits\ELC PemiitApp_ELR_ERE.doc Rev 05/21/2013 4404615T(1I/05/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 8420 SW LA MANCHA CT, TIGARD, OR, 97224 Residential - Electrical 199 Electrical final 2013-12-19 (null) ELC2013-00737 PASS - No C of O Reconnect only Violation Summary: Inspector Contractor