Permit CITY OF TIGARD ELECTRICAL PERMIT
711 8 . COMMUNITY DEVELOPMENT Permit#: ELC2015-00031
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/20/2015
Parcel: 2S103CD01400
Jurisdiction: Tigard
Site address: 13715 SW FAIRVIEW CT
Project: Heydlauff Subdivision: HOLLYTREE Lot: 18
Project Description: Add(2)branch circuits and alter(2)branch circuits
Contractor: PRIMARY ELECTRIC LLC Owner: HEYDLAUFF, GLORIA J
371 SE 13TH PLACE 13715 SW FAIRVIEW CT
CANBY,OR 97013 TIGARD, OR 97223
PHONE: 503-703-5989 PHONE:
FAX:
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo/Purchase 01/20/2015 $78.44
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/20/2015 $9.41
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
Required Items and Reports(Conditions)
This permit is iss -rt cub'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in cordance with -•'roved plans. This permit will expire if work is not started within 180 days of issuan e, or if work is suspended for more the 180
days. ENTION: Oregon la •r >s you to follow the rules adopted by the Oregon Utility Notification nter. ose ules are set forth in OAR
952-0 -0010 throu•h OAR 952-0■• 0090. You y obtain a copy of the rules or direct questions to OUNC by calling 503.232. 7•t 1.:0 0 3 . 44.
You 1
Is ed By: r t� �:! Permittee Signature: \
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' A ` 'Ij, 0 , Date: //ape/5—
LICENSE NO. / S S
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Applicat tCEIVEP I t>It (11 I l( l l ',1 t l\l l
City of Tigard ,) 2 0 2015 RDate/Bived: Q J Permit#: 6jCC�/r 3l
• 13125 SW Hall Blvd.,Tigard,OR 9 Plan Review Related Permit#:
• ' Phone: 503.718.2439 Fax: 5031$g ,6 Date/13 :
Inspection Line: 503.639.4175 1,1 l I OF TIGARI) Ready Date/By: lads RI See Page 2 for
\P I) Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction Addition/alteration/replacement Please check all that apply(submit I sets of plans w/items checked):
❑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.
151-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
❑Addition of new motor load of system.
Job#: Job site address: 1' 1 I S 5w A,Iz,,,,ew Cr 100HP or more. ❑ 'A",°E","l-2", `l-3",
City/State/ZIP: e� 1 A (,��, ❑Six or more residential units. occupancy.
ty J Ne-K 0 t 1 / P5 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: l 1 dvnrlc.1l ❑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'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
f� ` (with above sq.ft.) 75.00 2
[, New �'v 12C�l } Limited energy,multi-family
\\ �j residential(with above sq.ft.) 75.00 2
4\}Q ✓ C' cw�� Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER 1 ❑ TENANT Services or feeders installation,alteration,and/or relocation_
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) 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,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 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 51p./Q 2
branch circuit II//
City/State/ZIP: Each add'I branch circuit 3 7.42 -'-•72
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: PQ., �`c c.1`6z. t.C___ Lac. Sign or outline lighting 67.84 2
Address: 31 I $L i f-cl Cal.,
Signal circuit(s)or limited-energy ❑ See Page 2 2
P�� panel,alteration,or extension.
City/State/ZIP: e( j `27-7 b 3 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(5)S) -701 — c3 Fax:( ) Investigation(1 hr min) 66.25/hr
Industrial plant(1 hr min) 78.18/hr
Email:'Sbe°��V tflee.w Ave'CAAO\te • CO IA /° 7/G Inspections for which no fee is
CC c.: loc..(o1 S Electrical ic.: Col(( Suprv. Lic.: G�5 gs specifically listed(%:hr min) 90.00/hr
/Atli / _ /l,1 ELECTRICAL PERMIT FEES.
Sup .Electrician signature,required: 114-�lov
„� Subtotal: •7 '. yil
Print name: ,_ Date: 0 Plan Review Required(25%of pennit fee):
�uT7 Gt�D•/. I'�l�-7C�1
V State surcharge(12%of permit fee): 9, 9/
TOTAL PERMIT FEE:
Authorized signature: � �.
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.1 Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 440.4615T(11/05/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
systems combined: $75.00 Renewable tiara Qty. Each I Total
Fee for all residential s
y Rene electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
El Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
El Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 55226 2•
El 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
El 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(V5 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
' Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
El Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
n Medical
El Nurse Calls
n Outdoor Landscape Lighting*
El Protective Signaling
El Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014
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
13715 SW FAIRVIEW CT, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00031
Jeff Grove
Violation Summary:
Inspector Contractor