Permit CITY OF TIGARD ELECTRICAL PERMIT
11111 i COMMUNITY DEVELOPMENT Permit#: ELC2014-00399
TIGA.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/21/2014
Parcel: 2S 111 CC11000
Jurisdiction: Tigard
Site address: 15880 SW GREENS WAY
Project: Brown Subdivision: SUMMERFIELD NO.2 Lot: 137
Project Description: Electrical reconnect
Contractor: N/A Owner: BROWN, GARRY F
13625 113TH ST CT E
PUYALLUP,WA 98374
PHONE:
PHONE: 253-720-2630
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 07/21/2014 $67.84
Specifics:
1 ea 12%State Surcharge- 07/21/2014 $8.14
Electrical
Type of Use: SF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports(Conditions)
This pe is issued s to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be d a in accordance with -•.roved 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 la req you to follow the rules adopted by the Oregon Utility Notificati Center. Those rules are set forth in OAR
952- 01-0010 thro !h OAR 95. r01-1)0.0 Yo may obtain a cop of the rules or direct questions to OUNC by callin�5 , 2.1987 or 1.800.3 ..2344.
Iss d By: Permittee Signal e: �"f ��-
f
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 FOR OFFICE USE ONLY
EIPI Received „
City of Tigard 7 a/ c,/ Perrrrit : Zi C
v 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Related Permit#:
Phone: 503.718.2439 Fax: 503.598.1960 Date/B
Inspection Line: 503.639.4175 Ready Date/By: luris: B See Page 2 for
TIGARD_ Internet: www.tigard-or.gov NotiSed/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):
❑Service or feeder 400 amps or more ❑Building over three stones.
❑Demolition X Other:
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
X 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 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
❑IOOHP Addition of new.motor load of system.
Job#: Job site address: 15880 S.W.Greens Way I OOHP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:Tigard,OR 97224 0 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
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'1 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
(with above sq.ft.)
Electrical Reconnect
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
-- I - Renewable Energy _ ❑ See Page 2
❑ PROPERTY OWNER f ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name:Garry Brown 200 amps or less 100.70 2
Address:13625 113*St.Ct.E.
201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Puyallup,WA 98374 601 amps to 1,000 amps 301.04 2
Phone:(253)720-2630 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:bbrownscouts@aol.com relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 t
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 11 168.54 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 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax::( ) Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email: Reconnect only I 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: N/A Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ Page 2 2
Address:
panel,alteration,or extension.
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
specifically listed %:hr min) �•�hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: y � (
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
Subtotal: 67.84
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 8.14
Authorized signature: ____ TOTAL PERMIT FEE: 75.98
This permit application expires if a permit is not obtained within 180
Print name: Garry Brown Date: 7/16/2814 days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 440-46151(11/05/COM/WEB
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
15880 SW GREENS WAY, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00399
Jeff Grove
Violation Summary:
Inspector Contractor