Permit 1y q CITY OF TIGARD ELECTRICAL PERMIT
11 g • COMMUNITY DEVELOPMENT Permit#: ELC2015-00416
T I GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/28/2015
Parcel: 2S111AB02900
Jurisdiction: Tigard
Site address: 9345 SW MOUNTAIN VIEW LN
Project: Goodhouse Subdivision: ELROSE TERRACE Lot: 25
Project Description: Electrical reconnects for furnace and heat pump.
Contractor: OWNER Owner: GOODHOUSE,JOHN JAY
JOHN GOODHOUSE 9345 SW MOUNTAIN VIEW LN
9345 SW MOUNTAIN VIEW LN TIGARD,OR 97224
TIGARD,OR 97224
PHONE: 971-212-7533 PHONE: 971-212-7533
FAX:
FEES
Quantity Description Date Amount
2 ea Reconnect Only 05/28/2015 $135.68
Specifics: 1 ea 12%State Surcharge- 05/28/2015 $16.28
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $151.96
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 acc. •-• • 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. ATT •TION: Orego law re• you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-' 10 through OAR 952 '0 •'90./Yo ay obtain a,copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued : , � ' �•�. _ Permittee Signature: If
OWNER INSTALLATION ONLY
The installation is being made on•ro•erty I own ,•ich is not intended for sale,lease•r rent. 2r�
OWNER'S SIGNATURE i •�,.!%!!/'/ Date: �2S /Lj---
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' _ Date:
41011. 41,
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 1:0k OFFICE USE ONLY
City of Tigard RECEIVED Received
•t)neB ,-9tr A...2.,.., Permit No.: el_rl�z (�
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
114
Phone: 503.639.4171 Fax: 503.598.I960M I 2 8 2015 Date/B . Other Permit:
TIC;ARD
Inspection Line: 503.639.4175 Date Ready/By: suns ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIG.ARn Notified/Method: Supplemental Information
TYPE OFakIlliOING DIVISION PLAN REVIEW
❑ New construction in Addition/alteration/replacement
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: 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
IZ] 1-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑Installation of 75 KVA or
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A","E","I-2","I-3",
Job no.: Job site address: /y`_yit r i,,,iv ,v L I1' 100HP or more. occupancy.
0 Six or more residential units. ❑Recreational vehicle parks.
City/State/ZI P 77-7 `' ❑health-care facilities.
0 Supply voltage for more than
/ / Z//k d_ ❑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 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 145.15 4
La.add'I 500 sq.ft or portion 33.40 1
Tax map/parcel no.: Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.fl.)
�i t /� Limited energy,multi-family 75.00 2
�c 7�_ / 4.4,...4...<...,:).- /4—H/CC //T residential(with above sq.ft.)
Services or feeders installation,alteration,and/or relocation
200 amps or less 80.30 2
0 PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: i 401 amps to 600 amps 160.60 2
J f) x�, 6'(��1/aCLe,C, 601 amps to 1,000 amps 240.60 2
Address:4.'4,6 1w 44,d r44ti t,e,,, %�,. Over 1,000 amps or volts 454.65 2_
City/State/Z)P. p [� Temporary services or feeders installation,alteration,and/or
i(/ ei-cf relocation
Phone:( ti- )x r 7 739 Fax:( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale,lease,rent,or exchange,according to OR 4 9,6770,,�annd�701. 401 amps to 599 amps 133.75 2
Owner signature _. �� �s� %- -�-�/f� Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B.Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling,service and/or feeder 90.90 2
Phone:( ) Fax::( ) Reconnect only 2.., 66.85 J3tj-4 12
E-mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: D N E l2- Signal panel, or limited-
energy panel,alteration,or
Address: extension.Describe: I'age 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone:( ) Fax:( ) Investigation per hour(1 hr min) 62.50
CCB Lie.: Electrical Lie.: Suprv.Lie.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: //
3's•(rg
Print name: Date: Plan review(25%of ermit fee):
/j' �, /C" State surcharg o of permit fee): /,•aZ
Authorized signature: TOTAL PERMIT FEE: l Sf• 94-7
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.
C\BuildingWermits\ELC-P pp.doc 05/23/06 \ 440-4615T(II/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2- Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
ElAudio and Stereo Systems*
ElBurglar Alarm
El Garage Door Opener*
El Heating,Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918-260-260)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
ElData Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
ElInstrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
ElProtective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I.\&ulding\Pmnits\ELC-PermitApp.doc 0323/06
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
9345 SW MOUNTAIN VIEW LN, TIGARD, OR,
97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00416
David Young
Violation Summary:
Inspector Contractor