Permit CITY OF TIGARD ELECTRICAL PERMIT
111 ' ' COMMUNITY DEVELOPMENT Permit#: ELC2015-00528
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/08/2015
Parcel: 1S135DB11400
Jurisdiction: Tigard
Site address: 11333 SW 91ST CT
Project: Tenly Properties Subdivision: DAKOTA GROVES Lot: 7
Project Description: Reconnect A/C.
Contractor: JET INDUSTRIES INC Owner: TENLY PROPERTIES
1935 SILVERTON RD NE PO BOX 6839
SALEM, OR 97303 BEND, OR 97708
PHONE: 503-363-2334 PHONE:
FAX: 503-363-2622
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 07/08/2015 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 07/08/2015 $6.74
Type of Use: SF Electrical
Class of Work: ALT 1 ea Investigation Fee 07/08/2015 $90.00
Type of Const:
1 ea Investigation 12%State 07/08/2015 $10.80
Occupancy Grp: Surcharge
Total $163.72
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 0 952-001-0090. You may obtain a co f the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 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.
From: 07/08/2015 12:05 #141 P.002/002
Electrical Permit Applica4 ,C E I V E D I OR 01 1 R I I l 01\1 1
City of Tigard Received y _
Il I Date/B : / e !'7 r // i
61 1 3125 SW Hall Blvd.,Tigard,OR 97225/L 0 JI Plan Review
a Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175 CITY OF TIGARD Ready Date/By: B See Page 2 for
I I :�R 11 Internet: www.tigard-or.gov p t III DIN'''.. 1 4.01 O N Notified/Method. r Supplemental Information
UU
TYPE OF WORK PLAN REVIEW , .
❑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 0 Other:
where the available fault current ❑Marinas and boatyards.
CATEGORY.OF CONSTRUCTION "' exceeds 10,000 amps at 150 volts or ❑Floating buildings.
0 I-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.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND'-LOCATION ❑Emergency system. larger separately derived
J D Addition of new motor load of system.
Job#: Job site address:11333 91sT CT
I001-IP or more. ❑"A""E""1-2""l-3"
City/State/ZIP:TIGARD,OR 97223 D Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:TENLY PROPERTIES ❑Hazardous locations. ❑Supply voltage for more than
D Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE';SCHEDULE- ;
neacriptioa I Qty. I Each I Total 1 •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.addl 500 sq.ft.or portion 33.92 1
DESCRIPTION.OF WORK . Limited energy,residential
RECONNECT A/C (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
;E3-PROPERTY OWNER I ❑<TENANT Services or feeders installation,alteration,and/or relocation
Name:TENLY PROPERTIES 200 amps or less 100.70 2
Address: PO BOX 6839 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:BEND,OR 97708 601 amps to 1,000 amps 301.04 2
Phone:(541)480-4042 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 I
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
• . - Branch circuits-new,alteration,or extension,per panel
API,ICANT ❑ CONTACT PERSON A.Fee for branch circuits with
Business name:JET INDUSTRIES,INC. above service or feeder fee,
7.42 2
each branch circuit
Contact name:BEAR KORSNESS B.Fee for branch circuits without
service or feeder fee,first 1 56.18 56.18 2
Address: 1935 SILVERTON RD NE branch circuit
City/State/ZIP:SALEM,OR 97301 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)363-2334 Fax::(503)364-2488 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:ALICIA.0 @JETINDUSTRIES.NET Reconnect only 67.84 2
. CONTRACTOR Pump or irrigation circle 67.84 2
Business name:JET INDUSTRIES,INC. Sign or outline lighting 67.84 2
Address: 1935 SILVERTON RD NE Signal circuit(s)or limited energy
0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP:SALEM,OR 97301 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)363-2334 Fax:(503)364-2488 Investigation(1 hr min) 90.00/hr
Email:ALICIA.0 @JETINDUSTRIES.NET Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 3944 Electrical Lie.: C226 Suprv.Lie.: 5409S specifically listed(Y:hr min)
Suprv.Electrician signature,required: (— --1---�._„ ELECTRICAL PERMIT FEES
Subtotal: 56.18
Print name: CHRIS DUNLAP Date: 07/08/2015 ❑Plan Review Required(25%of permit fee): 0
State surcharge(12%of permit fee): 6.74
Authorized signature: c...-----v TOTAL PERMIT FEE: 62.92
c...-----v
This permit application expires if a permit Is not obtained within 180
Print name: CHRIS DUNLAP Date: 07/08/2015 days after it has been accepted as complete.
• Number of inspections allowed per permit. ., ' 1Q0• ill
I,Building'PermilvELC_PermitApp_ELR_ERE.doc Rea 06/172015 440-4615T(11'05.'COKWEB
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
11333 SW 91ST CT, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00528
David Young
Violation Summary:
Inspector Contractor