Permit 'PI _ CITY OF TIGARD ELECTRICAL PERMIT
r�• Permit#: ELC2014-00221
COMMUNITY DEVELOPMENT
Date Issued: 05/06/2014
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S134CD05500
Jurisdiction: Tigard
Site address: 11745 SW SUMMER CREST DR
Project: Miller Subdivision: BURLWOOD NO.3 Lot: 15
Project Description: (6)branch circuits for kitchen remodel.
Contractor: OWNER Owner: MILLER, DAVID L
11745 SW SUMMER CREST DR
TIGARD, OR 97223
PHONE 503-579-3239
PHONE:
FAX:
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo/Purchase 05/06/2014 $93.28
Specifics: Service or Feeder
1 ea 12%State Surcharge- 05/06/2014 $11.19
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $104.47
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 0 ,952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / 9�� Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being madeyapr I own which s t tend for sale,lease or rent. �J��
oped
OWNER'S SIGNATURE •
Date: (!� �(/q
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 RECEIVE I FOR OFFICE USE ONLY
City of Tigard MAY 6 2014 Received
Date/By: 6 y Permit No.: Z41020/9_O102.12/
r 13125 S W Hall Blvd.,Tigard,OR 97223 Plan Review 77
t I Phone: 503.718.2439 Fax: 503.598.196 CfrYOF I�GAn rr p° Date/By: Other Permit:
Inspection Line: 503.639.41 75 Date Ready/By. Juris. See Page 2 for
TIGARD Internet: www.tigard-or.gov BUILD�I PNVISIOP Notified/Method: 7/( ®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 0 Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
z 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","1-3",
Job no.: Job site address: 11745 SW Summer Crest Dr Six or more a rest occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: El Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. l Fee. l 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'1 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: /4:7 j'271--105 /g Z(pEr:3 Limited energy,residential
DESCRIPTION OF'WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family
75.00 2
Kitchen Remodel residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Add Appliance Circuits 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:David Miller 401 amps to 600 amps 200.34 2
Address: 11745 SW Summer Crest Dr. 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-)579-3239 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,I•. • rent,or . c ac . :ing to ORS 447,449,670, . d 11.
+F 401 amps to 599 amps 168.54 2
Owner signature: t .,,,., Date: � - Branch circuits—new,alteration,or extension,per panel
❑ APPLICANT A.Fee for branch circuits with
L`1'< OAT l'E N above service or feeder fee,
Business name: each branch circuit 7.42 2
B.Fee for branch circuits without I
Contact name: service or feeder fee,first
branch circuit 56.18 2
Address: Each add'I branch circuit 5 7.42 Si,q4 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 ' ;' 4 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.: Suprv.Lic.: specifically listed CA hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 73, as
Print name: Date: Plan review(25%of permit fee): —
State surcharge(12%of permit fee): j/, /g
Authorized signature: TOTAL PERMIT FEE: / q. y7
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\Permits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013 440-46151(11/05/COMMBB
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 Fee 1 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
n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
nBurglar Alarm 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
OAR 918-309-0040)
n Heating, Ventilation and Air Conditioning
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 mm) 66.25/hr 1
Inspections for which no fee is 90.00/hr
specifically listed('A 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
n Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n N• urse Calls
n O• utdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013
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
11745 SW SUMMER CREST DR, TIGARD, OR,
97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00221
Jeff Grove
Violation Summary:
Inspector Contractor