Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2014-00126
Date Issued: 03/18/2014
TIGARD 13125 SW Hall Blvd..Tigard OR 97223 503.718 2439 Parcel: 2S110AD90013
Jurisdiction: Tigard
Site address: 14848 SW 109TH AVE
Project: Jensen Subdivision: CANTERBURY WOODS CONDO Lot: 13
Project Description: Electrical reconnect only
Contractor: Owner: JENSEN, PHILIP J
14848 SW 109TH AVE
TIGARD, OR 97224
PHONE PHONE'
FAX
FEES
Quantity Description Date Amount
1 ea Reconnect Only 03/18/2014 $67 84
Specifics:
1 ea 12%State Surcharge- 03/18/2014 $8 14
Electrical
Type of Use: SFA
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 &dance 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. AT ENTION Oregon la -requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001 010 through OAR 9 -001-0 0. You may obtain as copy of the rules or direct questions to OUNC by 3-232.1987 or 1.800.332 2344
Issue& : ( _ ) �p'�°y-"`.k Rermittee Signatu . -e_Cr 7L1..._---
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.
1 -;. Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
S -!This permit card shall be kept in a conspicuous place on the job site until completion of the project.
��j;f /c p) Approved plans are required on the job site at the time of each inspection.
03/18/2014 02:44 3608851795 ALL AROUND MAINTENAC PAGE 01/01
.cal Permit A a t licati ECEIVED F'(112 OFFICE USE<3r1.,
City of Tigard j�%Y (t 1 PorntitNo.:flC'�d/ -eel 7.�
13125 SW Hall Blvd.,Tigard,OR 97220 AR 1 8 2014 Plan Review
• Phone: 503.7181439 Fax 503.598.1960 Dare/By Other Pamir.
i r. Ittspectioe Line: 503-639.4175 Date Ready/By: tur s. ® Sec Page 2 for
Internet: www.tigard-or.gov (..ITY OF TtGARD ttotified/Method' Supplemental In formation
[]New construction ❑Addit ion,alteration/rtpl>scCInellt PL.se check all that apply(submit 2 scu of plans N/lien].,hKked below).
0 Service or feeder 400 amps or more
❑Demolition / .� t�; ps (]Building over three stories
whore the available fault currcot ['Marinas ard boatyards.
exceeds 10,000 amps at 150 volts or ❑Floating buildings.
'..`_ r�^.0 x- ----- . .. -- -,T- . ___-._
v
less to Bound,or exceeds 14,000 ❑Commercial-use agricultural
. ►: 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps foe all other installations. budding¢
❑Multi farnily ❑Master builder ❑Other I ['Fare pump ❑tnatallation of ISO KVA or
Tt .t4-'24::".-.:i7:':''''
w G =``'r . -) .A. t.7-MY,a= f., i C i r -xa CI Emergency system larger soar-orb,derived system
"" _.d?",: . r, . i1..;4-'� 1,7, :,; ,g, --
O Addition of new motor load of ❑..A„..E.. ..I Z.._13..
Job no.: Job site address: ,',5'\� � f iD k n NI E- 100HP or more occupancy.
V �"YY ` ❑Six or more Ties Eential units. ❑Recreational vehicle parks.
City/State/ZIP: 1 l o.r a 'd� • . 0i-1 2 24 ❑ldealtb-care Facilities. ❑Supply voltage For more than
❑Hazardous locations 600 volts nominal.
Suite/bldg./apt.no. Project name: ❑Service or feeder 600 mops or more.
Cross street/directions to job site: " "� '�" �" '"
' Ilncnption 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 I 4
t
i Ea.add''500 sq.fry or portion 33-92 1
Tax map/parcel no-: Limited energy,residential
75.00 2
1 err
' • with above ft
Limited energy,multi faintly j
e ("L�F\rifl e tom- 00\\I residential(with above sq ft.) ` 7 5.00 2
'' C I_:Ra6iewablt loleil .r-r-p::';x 7{-1-See;Page'Z. _ ._29
Services or feeders installation,alteration,and/or relocation
r-r ,tR= --- --. ..__ -- .rci or less 100.70 - 2
---- _ -- � 200 amps l
• � �, ` y 201 amps to 400 amps 133.56 2
Name: p J 3 e,n c ! 401 amps to 600 amps I 200 34 -2
•Address: lib At) Svc \bOk i PY e . 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 ! 2 1
TCity/State/ZIP: , cinS' a q 77 24 , Temporary services or feeders installation,alteration,and/or
Phone:( ) 1 "" FSx:( ) relocation
700 amps or less 59.36 1
Owner installation:This installation is being made on properly 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-Delft alteration,or extension,per panel
1 Srj _et n _ r t ., 0• it�.t l► Sl d 3!, vn_ . E A.Fee far branch circuits with
i�J'aca 'ssr r.,-
above service or feeder fee,
Business name: \t r \ I. •L)v r J'1 J v C each branch circuit 7 d2 2
`r y r ` B.Fee for branch circuits without
Contact name: t Qv) a 1n O�� service or feeder fee,first
branch 56.18 2 ;
Address: ,b__5 G2 N / �[ Each add'l branch circuit 7,42 1 2
City/Sta ee/ZIP: �., d ,Q"-6r ekl \N `�1.-D l0"12 Miscellaneous(service or feeder not included)
a Each manufactured or modular 67.84 2
Phone:(-%0) �j�,-7- -2 Z0k , Fax: :(3(,b) : dwelling.service and/or Reds
��+ � I Reconnect only 67.84 ` + 2
E•ma& OlitgrGLty- 3 onajnipAan . ' 0. .p • CD re) . I Pump or irriganon circle 1 ` 67.84 - 2
i. � - - w-- ;-.7=,.:,..::, --_----_ - - Sign or outline lighting 67.84 2
Business name: ■ Signal circuit(s)or limited-cncrgy See
panel,alteration,or extension. _ Page 2 2
Address: Each aadltlonal inspection over allowable in any of the above
City/State/ZIP: Additional inspection(1 hr mm) 66.25/hr '
Invest:gatton(1 hr min) 66.25/hr
Phone:( ) Fax:( ) tadusmal plant(1 hr min) 78-18/hr
Inspections for which no fee is yo.00/hr
CC13 Lie:. i El-. trial Lic.: Suprv.Lie.: s ficalty�hstedd(Si hr min
,��.,.,:,',T "."1 .iE+7_�- �y li�!'7hl 1jj. t..1.�:i:L'tfFL.>J'+.L'.. -
Suprv.Electrician signature,required: l
Subtotal: t;-/ •'3-1
•
Print name: Date: Plan review(25%of permit fee):
��► State surcharge(12%of permit fee): •i'J -
Authorized signatur 44EL.W MIAs■ A. _ TOTAL PERMIT FEE: 75—.9%
! Tin► This permit application expires if a permit is not obtained witho 180
Print name: i i � �. days after It has beets accepted as eomple6e.
—
,�, .I l�' Ali r.. l
• • Number of inspections allowed per permit
t?a..imeeunw:mtc4bLC_PermitAVC_EI.R_E E.doe xr.0sn1/2015 •, .: 1(:1,05!COMAYEB
03/18/2014 00:41 3608851795 ALL AROUND MAINTENAC PAGE 02/03
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
ear•L- ,< - 2,_. =
Fee systems $75.00 =n ���;a ;� ' ,
for all residential s sterns co bined. rase
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva orless 100.70 2
5.01 to 15 kva 133.56 2
n A• udio and Stereo Systems` 15.01 to 25 kva 200.34 2
1=1 B• urglar Alarm Wi1dkeneration systems in excess of 25 kva:
25.01 to 50 kva 301.04
❑ Garage Door Opener* 50.01 to 100 kva 552.26 _
>100 kva(fee in accordance with 55226
❑ Heating,Ventilation and Air Conditioning OAR 9113-309-0040) _
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 I 7.12 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additioaal inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hf min) _
Inspections for which no fee is 90.00/hr
specifically listed st hr min)
.� :! J a�'E, ,,_6 4., ��.•v......�`e�nT d.-c�sF�a, .w '..�—.-' ..���^� - � •��9d^,'1'S '-'.i'.
Fee for each co
mmercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review;if required(25%ofpennit 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.eithin 180
❑ Audio and Stereo Systems days after it has bee*accepted as complete.
Number cif tnspccnens allcueti per permit
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
L Instrumentation
I I Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting'
I I Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I t&+ilciorPermKr\ELC PertnitApP—I1R_ERP doe Fr.J'.I'20:7