Permit 114 CITY OF TIGARD ELECTRICAL PERMIT
y •p Permit#: ELC2014-00257
s COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/19/2014
Parcel: 25101 BC00500
Jurisdiction: Tigard
Site address: 12300 SW KNOLL DR
Project: Stolt Subdivision: KNOLL ACRES Lot: 10
Project Description: (3)branch circuits to rewire 1st floor bedrooms.
Contractor: OWNER Owner: STOLT, FREDERICK
FREDERICK STOLT 12300 SW KNOLL DR
12300 SW KNOLL DR TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-312-0657 PHONE: 503 312-0657
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 05/19/2014 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 05/19/2014 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
Required Items and Reports(Conditions)
This pe is issued subject • 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 app• ed plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day . ATTENTION: Oregon law r =1you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
9 -001-0010 through OAR 952-00 1490. Yo .y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.3321,344. n
Issued By: �i �C/f �•� / Permittee Signature: rJ►1-C,tl� �
OWNER INSTALLATION ONLY
The installation is being made on property I own which is n• intende. •r ale, Bas- or rent. /-
•OWNER'S SIGNATURE I • ' 4 f,.. � � Date: S 9/1/
1/
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, 1 ()R (I 111( 1 1 ,,I ()NI
City of Tigard K�CEIVET� Received
`J f g Dateiv �'/ / 4.0.
, • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
s Phone: 503.718.2439 Fax: 503.598.1960 Date/B :
Inspection Line: 503.639.4175 MAY 1 9 2014 Ready Date/By: Juris: ® See Page 2 for
l 1(..A I:I) Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE ceiftteF'f y ) PLAN REVIEW
❑New construction ErAdditi ai p)y�meplivi n Please check all that apply(submit 2 sets of plans w/items checked):
l S ❑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.
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.
❑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: 133 co C,i K,,,<< 7r 100HP or more. ❑"A","E","I-z","1-3",
CI /State/ZIP: +� ❑Six or more residential units. occupancy.
tY / ❑Recreational vehicle parks.
/`op�d t ,2 a aa3 0 facilities. P
`I ❑Hazardous locations. ❑Supply voltage for more than
Suite/bldg./apt.#: Project name: i pion Ly�tr�rt 600 volts nominal.
i / ❑Service or feeder 600 amps or more.
Cross street/directions to job site: 1.1a II 5+1 `o K„„11 Dr. On it FEE SCHEDULE
I Description I Qty. I Each I Total I *
on L,e f h* #4 mq d r q g En 5 t
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'1 500 sq.ft.or portion 33.92 l
DESCRIPTION OF WORK Limited energy,residential 75.00 2
.nq �„ 4, s� r /vein lacy 1�
(with energy,multi-family ewf t J ! �ip d S Q I O Limiters energy,multi-family 75.00 2
residential(with above sq.ft.)
non - `,%a.t reledi 14)i re. Renewable Energy ❑ See Page 2
iROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 1-racie4.t c 5-4_0 l�- 200 amps or less 1 00.70 2
1��,.` 201 amps to 400 amps 133.56 2
Address:
I p�.�[L� so) Il nO I t Dr. 401 amps to 600 amps 200.34 2
City/State/ZIP: ! 1UY6/ � q a 3 601 amps to 1,000 amps 301.04 2
Phone: l�(o S t7 Fax: Over 1,000 amps or volts 552.26 2
(S03 ) y l ( ) Temporary services or feeders installation,alteration,and/or
Email: sib I 't-? 62 CO/,t e Gt 5 T.h N 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,rent,ore changg °tiding to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
u�( 401 amps to 599 amps 168.54 2
Owner signature: ����' Date: _���/- �4 _ _
Q;APPLICANT I ❑ CONTACT PERSON Branch circuits-new,alteration,or extension, l er panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
�� k S4 Fee branch branch circuit
Contact name: QI^LL S B.Fee for branch circuits without
service or feeder fee,first 1 56.18 c6,/I 2
Address: /ate SO J «n n 1 I Or branch circuit ��rr
City/State/ZIP:•--r�a r-d 0(z cr,a,a,3 Each add'I branch circuit 7.42 j'((.py 2
Miscellaneous(service or feeder not included)
Phone:( ) 3 1 _ at,S tl Fax: :( ) Each manufactured or modular 67 84 2
L dwelling,service and/or feeder
f-
Email: co( y��COMcliST, Nel-
Reconnect only 67.84 2
r CQNTRACTOR Pump or irrigation circle 67.84 2
Business name: nl�.J e v Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: Additional inspection(1 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(IA hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: -71.0 a
Print name: Date: ❑Plan Review Required(25%of permit fee): ._-
State surcharge(12%of permit fee): S 5-2.
Authorized signature: TOTAL PERMIT FEE: 7g.547
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.
1:\Building'.Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 440-4615T(11/05/EOM/WEB
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 Qty. I 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 to25kva 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 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on I'agc 1):
• Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n 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_PermitApp_ELR_ERE.doc Rev 04/21/2014
J
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:
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.
or
I 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.
irfeJar fa l�
Print Name of Permit Applicant
j2AmA c- jc — lLE
Signature of Permit Applicant Date
Permit* ( 0O/7—x 2-C7
Address: l0 irk• �.„,_, i-:•�;
oie
Issued bye( D. l14Date: 4//,/ 1�'
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
12300 SW KNOLL DR, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00257
Jeff Grove
Violation Summary:
Inspector Contractor