Permit 1s CITY OF TIGARD ELECTRICAL PERMIT
14 s . COMMUNITY DEVELOPMENT Permit#: ELC2014-00185
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/23/2014
Parcel: 2S111CB01703
Jurisdiction: Tigard
Site address: 10128 SW LADY MARION DR
Project: CORRIGAN Subdivision: HOOD VIEW Lot: 3
Project Description: (1)branch circuit for bathroom remodel.
Contractor: OWNER Owner: CORRIGAN, PATRICK H&KAREN A
PATRICK CORRIGAN 10128 SW LADY MARION DR
10128 SW LADY MARION DR TIGARD, OR 97224
TIGARD,OR 97224
PHONE: 503-598-4732 PHONE:
FAX: _
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 04/23/2014 $56.18
Specifics:, Service or Feeder
1 ea 12%State Surcharge- 04/23/2014 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 appl' -ble 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 s ended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. •_; ��e e_ set forth in OAR
952-001-0010 through OAR 952-001-0090. You cop a rules or ct questions to OUNC by calling 503.23 >i • 1 : 2344
Issued By: �� c - 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' 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 ION (II I1( I I S1 r1\I '
City of Tigard Received DateBy: 1( 1 i y �-� Permit No.: Pe-CO /L —0)C rS'
UPI
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
g Phone: 503.718.2439 Fax: 503.598.1960 /- j,� Date/By: Other Permit:
I : Inspection Line: 503.639.4175 Y �! Date Ready/By: kris: ® See Page 2 for
Internet: www.tigard-or.gov �^ Notified/Method: C Supplemental Information
TYPE O WORK ` 14451 �t PLAN REVIEW •
❑New construction ition/alteratioll/repftTt�entent G� Please check all that apply(submit/sets of plans w/items checked below):
��� St�� ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition 0 Other: Y 1%%\k where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTAU +: exceeds 10,000 amps at 150 volts or ❑Floating buildings.
,1\ less to ground,or exceeds 14,000 ❑Commercial-use agricultural
-and 2-family dwelling ❑Commercial/industria U `ccessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
LOCATION ❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND L
O ❑Addition of new motor load of ❑"A","E","I-2","I-3",
Job#: Job site address:/d/,2 $ 4 i �r �� 0 1 ooHP or more. occupancy.
_ G/�IJ t^ ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: cr., l •-) I�� q --4-/ ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.#: I Project name:c v fyy b4 0 ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Each I Total 1 •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot#: 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
(..i J y a ( (�tfi u,... bl,�}/_ rte ,• �r1�cle ( residential(with above sq.ft.)
1 ```r`�l 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: f /i,is i< II . Co P/r/ 4 401 amps to 600 amps . 200.34 2
Address: /v/ 5 C-cJ C.-,t.�/ �/► /∎/�./� 601 amps to 1,000 amps 301.04 2
a �� Over 1,000 amps or volts 552.26 2
City/State/ZIP: ) / ot r d Q 9 9-2.2_
[ � Temporary services or feeders installation,alteration,and/or
Phone:(5-03) `J —4/33_2 Fax:(5—)1 jJ- 6e - 47/'7 relocation
200 amps or less 59.36 1
Owner installation:This in ` io i be'ng made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,le. - �e , according to ORS 447,449,670,and 701.
f / , ,�/ 401 amps to 599 amps 168.54 2
Owner signature. Date: J Branch circuits—new,alteration,or ex tension,per panel
•
• APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
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 •I(Y 2
Address: Each add'l 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
Q �� panel,alteration,or extension. Page 2 2
Address: Each additional inspection over allowable in any of the above
City/State/ZIP: Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Industrial plant(1 hr min) 78.18/hr
Suprv.CCB Lic.: Electrical Lic.: Su Lic.: Inspections for which no fee is 90.00/hr
P specifically listed(/2 hr min)
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES d
Subtotal: S • I
Print name: Date: Plan review(25%of permit fee):
State surcharge(12%of permit fee): 0 .-71i
Authorized signature: TOTAL PERMIT FEE-I C7)01... 4A
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permiu\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 440-46I5T(I1/05/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 I Qty. I Each I Total I •
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
ElAlarm Wind generation systems in excess of 25 kva:
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 OAR918-309-0040)
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
❑ Each additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr 1
Inspections for which no fee is 90.00/hr
specifically listed(%z hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) • Number of inspections allowed per permit.
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
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
1.\Building\Permi ts\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants,exempt from licensing under ORS 701.010 (7), need not
submit this statement.This statement will be filed with the permit.
Please check the appropriate box:
1 I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
[ 1 will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
cO , r
Print Name of Perm't App• a '
Signature of Permit Ap• t Date
Permit#: _ / — , '/y' I/Ts- ,11111 ")
Address: y � / tr'J Or.
Q� - Yd
WV( iC M
• �V•
Issued by: J Date: /
This Copy for Permit Offices
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
10128 SW LADY MARION DR, TIGARD, OR,
97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00185
Jeff Grove
Violation Summary:
Inspector Contractor