Permit 111 CITY OF TIGARD ELECTRICAL PERMIT
3 •, COMMUNITY DEVELOPMENT Permit#: ELC2014-00154
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/03/2014
Parcel: 2S104AD02000
Jurisdiction: Tigard
Site address: 12605 SW 128TH AVE
Project: Lu Subdivision: BELLWOOD Lot: 47
Project Description: Replace electical service,utilize a temporary feeder during project and(2)branch circuits.
Contractor: TAKE CHARGE ELECTRIC INC Owner: LU, RANDY S& LORNA K
7270 NW HELVETIA RD 12605 SW 128TH AVE
HILLSBORO, OR 97124-8538 TIGARD, OR 97223
PHONE: 503-647-0946 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 04/03/2014 $100.70
Specifics: amps or less
1 ea Temp Services or Feeders- 04/03/2014 $59.36
Type of Use: SF 200 amps or less
Class of Work: ALT 2 crt Branch Circuits w/Purchase 04/03/2014 $14.84
Service or Feeder
Type of Const: 1 ea 12%State Surcharge- 04/03/2014 $20.99
Occupancy Grp: Electrical
Total $195.89
Required Items and Reports(Conditions)
This permi sue 'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do in accordance with pproved s. 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 I uires C' to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 01-0010 thro gh OAR 952-0 -0090. Y y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss ed By: �I �( 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'
/►_.STA' Date:
LICENSE NO. 367 5
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 ED I OR Ol'11( 1. 1 ".1 ON 1.1
Cl of TI A<0 Received Permit No.: �' _QQ�
13125 SW Hall lvd.,Tigard,OR 97223 P1anReview
��� � S
• Phone: 503.718.2439 l : 503.598.1960 Da1e/By: Other Permit:
I i ‘1:I 1 Inspection Line: 503.6395 ` UMD Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- i (,) IG Notified/Method: Supplemental Information
g uV I, PLAN REVIEW
❑New construction Addition/alteration/replacement
Please check all that apply(submit 1 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
Eff 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",
Job no.: Job site address: 121005 "1-3",
I OOHP or more. occupancy.
s� I Zg�.�� ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: 1. i Y tel l A ID ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: Li)._ ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: k ,()pll 1 �(J-\ Description I Qty. I Fee. I Total I •
�"` '� 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 _
sq. 75.00 2
DESCRIPTION OF WORK (with above q�ft.)
4Lehu � � �� QQ Limited energy,multi-family 7500 2
E�4rc 4.1-S 1A/1,)V�— residential(with above sq.ft.)
Renewable Energy _ ❑ See Page 2
Services or feeders installation,alteration,and/or_ relocation
❑ PROPERTY OWNER I ❑ TENANT 200 amps or less ` 100.70 i()‘10 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
Phone:( ) Fax:( ) relocation
200 amps or less I 59.36 51 -IL, I
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 pane
❑ APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with ��
above service or feeder fee, Z 7 42 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first
branch circuit 56.18 2
Address: Each add'I branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular I 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:�^f j!o ` ,. I Signal circuit(s)or limited-energy See
t`^"��V �uC N� panel,alteration,or extension. Page 2 2
Address: —)----', O k W Q y, .yam p.0 Each additional inspection over allowable in any of the above
Y, !' Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: 4)k `lS v-t, 012_ en12 Investigation(1 hr min) 66.25/hr ,
Phone:( b f -Oq c-(6, Fax:( ) .je Industrial plant(1 hr min) 78.18/hr
l� ?fifty Inspections for which no fee is
CCB Lic.: S. 6i.o i Electrical Lic.:3L{_ Suprv.Lic.: 3(�?� specifically listed(V2 hr min) 90.00/hr
Suprv.Electrician signaturerequir� �o/, �F ELECTRICAL PERMIT FEES
Subtotal: 111-1 10
Print name: <et) a- +1 A vo I ` Date: '--2 6(y Plan review(25%of permit fee):
( State surcharge(12%of permit fee): 'ZO,9'1.
Authorized signature: TOTAL PERMIT FEE: t' S s VI
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
' Number of inspections allowed per permit.
I:\Buildingtpermits\ELC_PermitApp_ELR_ERE.ifoc 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 1 Qty. I Fee I Total
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva orless 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 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 over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
111 Other: additional inspection over allowable in any of the above:
Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min) •
Inspections for which no fee is 90.00/hr
specifically listed(V: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*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I1Building\Permits\EL.C_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
12605 SW 128TH AVE, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
2014-04-15 00:00:00
ELC2014-00154
PASS - No C of O
Violation Summary:
Inspector Contractor