Permit CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit#: ELC2015 00086
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/11/2015
Parcel: 1 S126DC01001
Jurisdiction: Tigard
Site address: 9335 SW LEHMAN ST
Project: TOBEY Subdivision: LEHMANN ACRE TRACT Lot: 5
Project Description: (1)branch circuit for ground rod installation.
Contractor: AC ELECTRICAL CONTRACTOR LLC Owner: TOBEY, MARSHA L
5 CENTER POINTE DR SUITE 400 9335 SW LEHMAN ST
LAKE OSWEGO, OR 97035 TIGARD, OR 97223
PHONE: 503-910-3514 PHONE:
FAX: 503-845-9633
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 02/11/2015 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 02/11/2015 $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 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 OAR 952-001-0090. Y• ••. • the rules or direct questions to OUNC by callin 3 .1987 r 1.800.332 344.
By: — i / Signature: �� Q_ �A's:\\NZ
Issued B -��� Permittee �
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 -11 FOR OFFICE USE ONLY
Received
City of Tigard ct‘N / J L'-4-51---' Permit No.: r'
• 13125 SW Hall Blvd.,Tigard,iktikl Plan Revie..r/1/ CLC`�t j --QW'• Phone: 503.718.2439 Fax: 98.1960 15 Date/By. Other Permit: Ora°ts_.y t�,^,L.r4
TIGARD Inspection Line: 503.639.4175 QQ 1 , 20 Date Ready/By: Juris: 63 See Page 2 for ��,(t.11 ��
Internet: www.tigard-or.gov ��V 1 �r` Notified/Method: �'fp Supplemental Information
V
TYPE OF W �V /,' PLAN REVIEW
> � 4 �
❑New construction �Addition/al 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: 'NU' where the available fault current
❑Marinas and boatyards.
i{ 5,1*�y R k,,',- '4',-\\^ """ ) t ' y b,„ i,E ?gV exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
;g 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: r ,
_ ` 100HP or more. occupancy.
3 �k. l E N V� *t.( SA- ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: ❑Health-care facilities. ❑Supply voltage for more than
O l` 0 0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: I Project name: ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I 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'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no
Limited energy,residential
',wow (with above sq.ft.) 75.0 2
Limited energy,multi-family 75.00 2
dd Q�`cr� Nt OA S c Cu 0 t✓ residential(with above sq.ti.)
J Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
'may '' 200 amps or less I I 100.70 2
"" 201 amps to 400 amps 133.56 2
Name' 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) I Fax:( ) relocation
200 amps or less 59.36 I
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,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or ex_tension,per panel
""$ A.Fee for branch circuits with
' - ?'w, r .- �`. -,' above service or feeder fee,
Business name: each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name: service or feeder fee,first 56.18 •11 2
branch circuit
Address: Each add'I branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67 84 2
Phone:( ) I Fax: :( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
gs, a .. ., s..," f° t ,t- ,ai t �- Sign or outline lighting 67.84 2
Business name: ( 1 C \ I /t Signal circuit(s)or limited-energy See
P e O v< d� 4 Q Y L�.f+t� panel,alteration,or extension. Page 2 2
Address:_e v. try pL,ul Q No P ko 1 Each additional inspection over allowable in any of the above
City/State/ZIP: ` ( `J Additional inspection(I hr min) 66.25/hr
ty h t}1 l Q�C(i L Q (z_ Investigation(1 hr min) 66.25/hr
Phone:(5Q3) C�t >- Si dx:(5d3) �C1� �` - Industrial plant(1 hr min) 78.18/hr
p Inspections for which no fee is 90.00/hr
CCB Lic.: / 3C( Electrical Lic.: c O l Suprv.Lic.:SO (9.E specifically listed(%hr mm)
r tEr*rsfA■ °'' '
Suprv.Electrician signature,required:Qti.. e, Ctn., ,' Subtotal: S
Print name: bia_/L 4_ ``\0. Date: QI /// ' Plan review(25%of permit fee):
1 L State surcharge(12%of permit fee): r."—ill
Authorized signature: TOTAL PERMIT FEE: t,). c .
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(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
9335 SW LEHMAN ST, TIGARD, OR, 97223
Residential - Electrical
195 Misc. inspection
PASS
ELC2015-00086
Jeff Grove
Violation Summary:
Inspector Contractor