Permit 11111 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2015-00091
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/12/2015
Parcel: 2S109AB07200
Jurisdiction: Tigard
Site address: 13115 SW ST JAMES LN
Project: Walker Subdivision: RAVEN RIDGE Lot: 1
Project Description: (3)branch circuits for bath remodel
Contractor: OWNER Owner: WALKER,TIMOTHY E&LORINA B
TIM WALKER 13115 SW ST JAMES LN
13115 SW ST JAMES LN TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 503-880-7132 PHONE: 503-880-7132
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 02/12/2015 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 02/12/2015 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law, All work will
be done in - c• ._• - with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ' ENTION: Ore.: law re• fires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-0%1-0010 through OAR 9 '-01 10.0. may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Is ued By: k `/� �r Lj .A1 Permittee Signature:
X
OWNER INSTALLATION ONLY
The installation is being made on property I own which i not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE ONLY
Received
City of Tigard Date/B : :�� Permit No.: `, �D.
2 13125 SW Hall Blvd.,Tigard,OR 972238 EC E I V E ,I Plan Review ether Permit:
Phone: 503.718.2439 Fax: 503.598.19 Date/
I I GARD Inspection Line: 503.639.4175 2 Date Ready/By: turfs: RI See Page 2 for
Internet: www.tigard-or.gov FEB 1 2 20 5 Notified/Method: %'(o Supplemental Information
TYPE OF WO
` +ITY OF TIGARD PLAN REVIEW❑New construction Addition/alte Please check all that apply(submit 2 sets of plans w/items checked below):
rU$l UH4 rOIVIStON
0 Service or feeder 400 amps or more 0 Building over three stones.
❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
xi 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: 13 115 S It-) si -3-km Es L/) six or ores. Recreational❑Six or more residential units. ❑Recreational vehicle parks.
❑Health-care facilities. ❑Supply voltage for more than
City/State/ZIP: r-1 d Z 9X224' ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I qt.. 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
Tax map/parcel no.: Ea.add'I 500 sq.ft.or portion 33.92 I
Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
•
t� Limited energy,multi-family
3 ATH !�--m�FL residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
XPROPERTY OWNER I ❑ TENANT
200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name:
I M A t 7Z. 401 amps to 600 amps 200.34 2
Address: 1 3115 S!o ST a--mt fS no 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: 11 4 4q art_ '9-Z if Temporary services or feeders installation,alteration,and/or
Phone:(r(7 ) ieo ,.313 Z_. Fax:(5°3 ) l_, , ee.„4(a- relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not tot amps to 400 amps 125.08 2
intended for sale,lease,ren or exchange,according to ORS 447,449,670,and 701. •
401 amps to 599 amps 168.54 2
Owner signature: Date:Z/I//LS Branch circuits—new alteratio r extension,per panel
❑ APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits write
above service or feeder fee,
Business name: each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name: service
circuit
fee,first 1 56.18 5-4 Jg 2
Address: Each add'l branch circuit Z 7.42 N.gf! 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 Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy See
Business name: 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('/,hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
Subtotal: 71• O a
Print name: Date: Plan review(25%of permit fee): •
State surcharge(12%of permit fee): $- 5 a.
Authorized signature: TOTAL PERMIT FEE: 7 q.S
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.doc Rev 05/21/2013 4404615T(11/05/COM/WEB
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:
1 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.
i tit CD P1 L
Print Name of Permit Applicant
-
Si 2natur-if Permit Applicant Da j e ii
Ek0 '10)43 Cc %/1
H Permit#: I `fc 9G1S- Cc;C;7(t, A.t1?a15 ;c/
Address: / 31/ S J,...) 11-e-ii .; -,�' �
4:i
y
`Issued by:2 /2/c Dater Copy for Permit Offices