Permit CITY OF TIGARD ELECTRICAL PERMIT
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c 2 • - COMMUNITY DEVELOPMENT Permit#: ELC2015-00320
• 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/04/2015
TIGARD Parcel: 2S109BA01900
Jurisdiction: Tigard
Site address: 13969 SW LEAH TER
Project: Hosoda Subdivision: HILLSHIRE SUMMIT Lot: 4
Project Description: (1)branch circuit for lights in entry closet.
Contractor: DICKINSONS ELECTRIC Owner: HOSODA, GORDON&CENDRINE
8449 SW BARBUR BLVD 13969 SW LEAH TER
PORTLAND, OR 97217 TIGARD, OR 97224
PHONE: 503-246-3550 PHONE.
FAX: 503-213-6049
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 05/04/2015 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 05/04/2015 $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 OF�R•952 21 -i'90. Yo may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19: :_1.8� -
Issued By: ,"1-
l `(. 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.
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 RECEIVE.
City of Tigard Received /� /S A�/�oo3
MAY 4 DateBy: Permit#: `•
;� 13125 SW Hall Blvd.,Tigard,OR 97223 2015 5 Plan Review
• Phone: 503.718.2439 Fax: 503.598.1960 Date/By:/ u'` Datey: Related Permit#:
Inspection Line: 503.639.4175 CITY o F'I IGARD Ready Date/By: lures: Ir! See Page 2 for
11 ....mmiiimiliiiiiiiiiiiiimmi`' Internet: www.tigard-or.gov Notified/Method: 776--- Supplemental Information
❑New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 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.
exceeds 10,000 amps at 150 volts or ❑Floating buildings.
1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
,,-,/, � ❑Emergency system. larger separately derived
Job#: Job site address: teat/ �r Addition of new motor load of system.
100HP or more. ❑"A" "E" "1-2" "1-3"
City/State/ZIP: ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: ,, ,
Description Qty. Each Total *
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Limited energy,residential 75.00 2
Zal Cl (with above sci ft.)
Limited energy,muhi-family
residential(with above sq.ft.) 75.00 2
4 Renewable Energy ❑ See Page 2
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:( ) I 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 1 168.54 2
Branch circuits—new,alteration,or extension, er 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 /
service or feeder fee,first 56.18 2
Address: branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
•
Pump or irrigation circle 67.84 2
Business name: r 4vt /3/7 Signor outline lighting I 67.84 2
�n ^ ��
f' pineal cl a ti n or lextension. ❑ See Pa e 2 2
Address: 5i L- e3 4r W panel,alteration,or extension. g
City/State/ZIP: / _Each additional inspection over allowable in any of the above
v Additional inspection(1 hr min) 66.25/hr
Phone:( J..`) c 2_7—It Fax:(�, / 3 6'c' { 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 Lice—c3 y I Electrical Lic.:;.?b,-fr��e-Suprv.Lic.: 3��-
specifically listed 'A hr min
Suprv.Electrician signature�•�_�;/� f _ Subtotal: 4 , ii,
Print name: J� Date: �—'L /✓ ❑Plan Review Required(25%of permit fee):
�' % State surcharge(12%of permit fee): 4 r ?y
Authorized 'gnature:
TOTAL PERMIT FEE: t- 902
Print name: Datec—fit This permit application expires if a permit is not obtained within 180
r/J days after it has been accepted as complete.
r_. ,
Number of inspections allowed per permit.
1:\BuildinePermita\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: 1
Fee for all residential systems combined: $75.00 Description o° o e n Total •
Y Renewwable electrical energy systems:
Check Type of Work Involved: 5 kva or less 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 over25 7.42 3
❑ Vacuum Systems* >l00 kva—no additional charge I 0.0 3
Each additional inspection over allowable in any of the above:
El Other Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr
Inspections for which no fee is 90.00/hr
sr-cificall listed /2 hr min
COMMERCIAL WORK ONLY: , ; ; _( l :, MLA
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
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ 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
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13969 SW LEAH TER, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Electrical ELC2015-00320
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Light and plugs in bedroom addition.
Violation Summary:
Inspector Contractor