Permit t p CITY OF TIGARD ELECTRICAL PERMIT
s, COMMUNITY DEVELOPMENT Permit#: ELC2015-00269
T[CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/21/2015
Parcel: 1 S 125DA07500
Jurisdiction: Tigard
Site address: 9375 SW 69TH AVE
Project: JENSEN Subdivision: KINGS VIEW Lot: 61
Project Description: (1)200 amp service installation.
Contractor: OAKLEY ELECTRIC INC Owner: JENSEN,VIRGINIA N
4120 SE INTERNATIONAL WY STE A-102 9375 SW 69TH AVE
MILWAUKIE, OR 97222 TIGARD,OR 97223
PHONE: 503-855-4719 PHONE:
FAX: 503-908-1729
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 04/21/2015 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 04/21/2015 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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. You mav,ahtain a f tpe les or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: — Permittee Signature: L/ 4s)-i
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.
Apr 21 15 06:12a Oakley Electric 503-908-1729 p.1
Electrical Permit ApplicationRECEIVE' I ( k t)h r l( r I ,,1 (r.1 ,
City of Tigard e—,..401t Received
IN n 13125 SW Hall Blvd.,Tigard,OR 97223 �' DatelB ' �/ /S i1J
a r R 21 01 Plan Revi
a Phone: 503 718.2439 Fax: 503.598.196d t3ateB : Other Permit
T 1 4 u p Inspection Line: 503.639.4175 Date Ready/By IN See Page 2 for
Internet: waw.tigard-or CITY Y(J I l(`]�A1(t) Notified/Method: Supplemental Information
PE OF /404*DING 1)1 N ISI01\ PLAN REVIEW
❑New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans wfitems checked below):
Q Dem 'ion ❑Other ❑Servi0e or feeder 400 amps or more ❑Building over three stones.
when the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
l-and 2-family dwelling Commercial industrial less to grand,or exceeds 14,000 ❑CormmerciaF,sse agricultural
y g ❑ ❑Accessory building amps for all other installations. building
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 K V A or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition oCnew motor load of ❑'A "E°"1-2" I-3",
Job no.: Job site address:9'3 7 5 (A) // 100in'or more. Recreational(9� ��� ❑Six or mote residential units. ❑Recreational vehicle parks.
City/State/ZIP: err)) �Q 1�a3 ❑Health-care facilities. ❑Supply voltage for more than
�� ice` v't 1 r ❑Hazardous locations 600 volts nominal.
Suite/bldg../apt.no.: Project name: ❑Service or feeder 600 amps or mom.
SCHEDULE
Cross street/directions to job site: Description I Qty. 1 Fee. I Taint I .
New residential single-or multi-family dwelling snit.
Indasks attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 14
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax trap/parcel l no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family
75.00 2
(tar * residential(with above sq.It)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER I ❑ TENANT 200 amps or less L 100.70 IT
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:( ) Fax:( ) relocation
200 amps or less 59.36 1
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—nets,alteration.or extension,per panel
❑ APPLICANT i ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee. 7 42 2
Business name: each branch circuit
B.Fee for branch circuits withow
Contact name: service or feeder fee,first
branch circuit 56.18 2 I
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:( ) Fax::( ) . dwelling,service and/or feeder
/ Reconnect only 67.84 2
E-mail: /(�g_ool(IC.rLItc.r.�., Pump or irrigation circle 67 84 2
{ (� CONTRACTOR Sign or outline lighting 67 84 2
Business name: (�'� I'`e.C ,�' „, Signal circuit(s)or limited-energy See
rr1 111 U` panel,alteration.or extension. Page 2 2
Address: cii oZ 0 c .1 Z` 4Q Lu p�1Ae..p—II Each additional inspection over allowable in any of the above
City/State/ZIP: 1 Additional inspection(l hr min) 66.25/hr
l �GiC� t ) 0 I i Investigation(l hr min) 66.25/hr
Phone:( )3) 1 0�j-Qs I a I Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 9Q,00!hr
CCB Lie.: 16.-Li 5 k S E ical Lie. Suprv.Lie.: 1, 5 specifically listed(',4hrmin) _
1 'n" ELECTRICAL PERMb FEES
Suprv.Electrician signature,required: V
Subtotal: 1
Print name:�-1`,�J 1 rs .C_ " Date:i � j r Plan review(25°/.of permit fee):
/ State surcharge(12%ofpermit fee): 0.()
Authorized signature: ( Lr"—^r-------,, TOTAL PERMIT FEE:
Print name: t r-�,`� Date:Li -'i 1 s^ This permit application expires if a permit is not obtained within 180
11 7 � 1 J days after it has bee,accepted as nmpktt
• Number of inspections allowed per permit.
11dluildip'4 nitstELC PrmitApp ELA FRE.dot Rev 05/21/2013 410-4615T(1IOO5./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
9375 SW 69TH AVE, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00269
Jeff Grove
Violation Summary:
Inspector Contractor