Permit y u CITY OF TIGARD I•
ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT
/ Permit#: ELC2014-00190
T IGA.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/24/2014
Parcel: 2S 102AB00910
Jurisdiction: Tigard
Site address: 12145 SW 92ND AVE
Project: LARSON Subdivision: KIMBERLY ADDITION Lot: 10
Project Description: Installing a new 200 amp meter main,replacing an existing panel with a sub panel,and adding(10)branch circuits.
7/15/14,Reprinted to add(5)additional circuits.
Contractor: OWNER Owner: LARSON,ALEC E
ALEC LARSON 12145 SW 92ND AVE
12145 SW 92ND AVE TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-706-8902 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Services or Feeders-200 04/24/2014 $201.40
Specifics: amps or less
15 crt Branch Circuits w/Purchase 07/15/2014 $111.30
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 07/15/2014 $37.52
Electrical
Type of Const:
Occupancy Grp:
Total $350.22
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 don= accordance 'th 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. •TTENTION: Oregon aw requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-0,1-0010 throygh OAR 952-.11-1!•0. Y•u may obtain a copy of the rules or direct questions to OUNC by calling 503.232. 7 or 1.800.332 2344
Issu=• By: � / ' Permittee Signature: /)'- d(F//�T)}Vl�""�
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 503.639.4176 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 Applicatio FOR()FFIC F: ENE ol.l
City of Tigard 'RECEIVED Dateivea � Permit# / —ct 1/
;. •• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.196 It I 1 DateB : Related Permit#:
Inspection Line: 503.639.4175 '"�- 2�14 Ready Date/By: Juris: ® See Page 2 for
I I 1, \VP Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF�j tcY OF 1'IGARI) - PLAN REVIEW
❑New construction ❑Addition/altd►�tlbp►t� DIVISION Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
ElDemolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
El 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
Cl Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 4,114/c bw 9? .1-/e, I00HP or more. ❑"A","E","l-2","1-3",
City/State/ZIP: ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
n �o�D (with above sq.ft.) 75.00 2
ate'�" (C) 1// e-� Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
PROPERTY OWNER I ❑ TENANT Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name: A I& G 1.. A✓50-1.. 200 amps or less 100.70 2
Address: I Z )t{rj S l✓ 071 hO l II w(.... 201 amps to 400 amps 133.56 2
n /� 401 amps to 600 amps 200.34 2
City/State/ZIP: r.`y4.„5v( 1J lZ °I7 ) 2.3 601 amps to 1,000 amps 301.04 2
Phone:( 0; 7 0 6 13_I 0 L Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease, or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: _ --A--- Date: 7-1 .-)i 1 y 401 amps to 599 amps 168.54 2
❑ APPLICANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit S 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
� CONTRACTOR Pump or irrigation circle 67.84 2
Business name: f/a.) Sign or outline lighting 67.84 _ 2
`C Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: panel,alteration,or extension. g
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 66.25/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(%3 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature 10I4.4/1 TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within I80
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doet Rev 04/21/2014 440-4615T(I1/05/COFUWEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I 00'. 1 Each I Total I "
Fee for all residential systems combined: $75.00 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
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 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 66.25/hr I
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%2 hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONLY: Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ 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
I�\Building\Permits\ELC_PemtitApp_ELR_ERE.docx Rev 04/21/2014
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2014-00190
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/24/2014
Parcel: 2S 102AB00910
Jurisdiction: Tigard
Site address: 12145 SW 92ND AVE
Project: LARSON Subdivision: KIMBERLY ADDITION Lot: 10
Project Description: Installing a new 200 amp meter main,replacing an existing panel with a sub panel,and adding(10)branch circuits.
Contractor: OWNER Owner: LARSON,ALEC E
ALEC LARSON 12145 SW 92ND AVE
12145 SW 92ND AVE TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-706-8902 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Services or Feeders-200 04/24/2014 $201.40
Specifics: amps or less
10 crt Branch Circuits w/Purchase 04/24/2014 $74.20
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 04/24/2014 $33.07
Electrical
Type of Const:
Occupancy Grp:
Total $308.67
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 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by callin 3.232.1987 or 1.800.332.2344.
i
Issued By: �: t Permittee Signature: Y �^
Ara/
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.
ALUL' 1V117
Electrical Permit Application_ OR OFFICE USE ONLY
A'R 2 4 2014
City of Tigard Received DateBy: 11 ��K - Permit No �LI. --r~t,t 4b
_� 13125 SW Hall Blvd.,Tigard,O 'lQ,dF TIGARD Plan Review Other Permit.
= Phone: 503.718.2439 Fax: 501:518.1'960' DateBy:
TIGARD Inspection Line: 503.639.417BUILDING DIVISION Date Ready/By Jun 65 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: ! ( Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ®Addition/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
® I-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: 12145 SW 92ND AVE IOOHPor more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:CENTER Description I Qty. I Fee. I Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision:KIMBERLY ADDITION Lot no.: 10 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
'Fax map/parcel no.:2S102AB00910 Limited ener •
gy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
' Limited energy,multi-family 75.00 2
NEW 200 AMP METER MAIN,REPLACE EXISTING PANEL WITH SUB residential(with above sq.ft.) _
' Renewable Energy ❑ See Page 2
PANEL,ADD NEW BRANCH CIRCUTS Services or feeders installation,alteration,and/or relocation
® PROPERTY OWNER ❑ TENANT 200 amps or less 2 100.70 201.40 2
201 amps to 400 amps 133.56 2
Name:ALEC E LARSON 401 amps to 600 amps 200.34 2
Address: 12145 SW 92"d AVE 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:TIGARD,OR 97223 Temporary services or feeders installation,alteration,and/or
Phone:(503)706-8902 Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is bei t_made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,le rent,or exchang- . cording to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: ■ , e: . Branch circuits—new,alteration,or extension,,per panel
❑ APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
. -- above service or feeder fee, 10 7 42 74.20 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first 56.18 2
branch circuit
Address: Each add'I branch circuit 7.42 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 Lic.: Electrical Lic.: rSuprv.Lic.: specifically listed(%2 hr min)
',..
Suprv.Electrician signature,required: E � �4,a.�
Subtotal: .---,�
Plan review(25%of permit fee):
Print name: Date: State surcharge(12%of permit fee): 3 3.0 7—
Authorized signature: TOTAL PERMIT FEE: SCS, 491
Date:
I Z3 This permit application expires if a permit is not obtained within 180
Print name:
e c.. LGf' n tt y days after it has been accepted as complete.
4 * Number of inspections allowed per permit. -i- PO.10
I\Building\Permits\ELC_PennitApp_ELR_ERE.doe Rev 05/21/2013 440.4615T(1 t/0S/COM/WEB '. (Cj V gV
A ssG. s-,
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12145 SW 92ND AVE, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00190
Jeff Grove
Violation Summary:
Inspector Contractor