Permit ,, CITY OF TIGARD ELECTRICAL PERMIT
11/II COMMUNITY DEVELOPMENT Permit#: ELC2015-00124
Date Issued: 03/02/2015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111 D612600
Jurisdiction: Tigard
Site address: 9430 SW LAKESIDE DR
Project: Blanchard Subdivision: SUMMERFIELD NO.12 Lot: 677
Project Description: Kitchen and bathroom remodel.
Contractor: ROTH HEATING&COOLING Owner: MORRISON, ROY E&SUSAN
PO BOX 1265 PO BOX 771
CANBY, OR 97013 LA CENTER,WA 98629
PHONE: 503-266-1249 PHONE:
FAX: 503-266-3478
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 03/02/2015 $100.70
Specifics: amps or less
4 crt Branch Circuits w/Purchase 03/02/2015 $29.68
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 03/02/2015 $15.65
Electrical
Type of Const:
Occupancy Grp:
Total $146.03
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 ccordanc- .ith 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. TTENTION: Oregon law :•uires you to follow the rules adopted by the Oregon Utility Notificatio nter Those rules are set forth in OAR
952- 01-0010 through OAR 952 41-0060. •u may obtain a copy of the rules or direct questions to OUNC by calling 503. 1987/or 1.800.332.2344.
Iss ed By: cw ��s�ill 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' Date:
LICENSE NO. U J 3 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 Application TOR Orrlc I': 1 '4 u\I 1
City of Tigard \' Received
III 13125 SW Hall Blvd.,Tigard, 9 , Y�D Da view a
• Phone: 503.718.2439 Fax: 503.59C DateB Related Permit#: CO20 _ r
Inspection Line: 503.639.4175 41 72Q115 Ready Date/By: Juris: 65 See Page 2 for
I K I) Internet: www.tigard-or.gov MAR D pp
���,,,ppp Notified/Method: c Supplemental Information
E OF WORK of T� eAoN PLAN REVIEW
❑New construction Addition/alteratlatl� tt� , Please check all that apply(submit 2 sets of plans w/items checked):
B* ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: J, where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
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.
El 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#:-'�),1 fo)._ p Job site address: 1 t2o Ski L4 la s 10 e_. W. 100HP or more. ❑"A","E","t-2","1-3",
City/State/ZIP: 1 ❑Six or more residential units. occupancy.
ty `1�jR� q 1 (� y ❑Recreational vehicle parks.
(� ❑Health-care facilities. Par
Suite/bldg./apt.#: Project name: ?/..,46)(4114 RD ❑Hazardous locations. ❑Supplylvoltage nar more than
❑Service or feeder 600 amps or more.
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 75.00 2
TA ``'' Q ; (with above sq.ft.)
✓tt-. C,NAnIGE 1 et 4C#44‘) 124iii 12444-) t'_• Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
❑ PROPERTY OWNER ❑ TENANT Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 1 100.70 100.7D 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
FWIPPLICANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:244(44 l� 1.464.iT( )r i (q�>4 fat, , above service or feeder fee, L/ 7.42 ?q. �yr 2
each branch circuit
Contact name: t N-- II B.Fee for branch circuits without
Si��SUtJ
���� ���� service or feeder fee,first 56.18 2
Address: v,..) - branch circuit
City/State/ZIP: Coil,) ,./ p? 9703 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) -- !Pill Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: ket/t t)5 a - F.(eirr,Co,t,N Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
-
Business name: DD Sign or outline lighting 67.84 2
ICD�l. f �h� �t 4.�{
Address: (J Signal circuit(s)or limited—energy ❑ See Page 2 2
panel,alteration or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
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.: /' r Electrical Lic.: $ j - Suprv.Lic.: 6-o u- S specifically listed CA hr min)
ELECTRICAL PERMIT FEFB�
Suprv. Electrician signature,required: J T
ti C ( Subtotal: )3Q, 31
Print name: 14(/c ,�l Mtf S vJ Date: 3/9-7I s ❑Plan Review Required(25%of permit fee):
1 State surcharge(12%of permit fee): I ias
Authorized signature: TOTAL PERMIT FEE: 6.03
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 04/21/2014 440-4615T(11/05/COM/WEB
r
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 1
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kvaorless 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 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
H 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
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(A hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
•
(SEE OAR 918-309-0000) Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
H Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:1 Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 0421/2014
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
9430 SW LAKESIDE DR, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00124
David Young
Violation Summary:
Inspector Contractor