Permit n CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2015-00646
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/13/2015
Parcel: 1 S125DA09800
Jurisdiction: Tigard
Site address: 6906 SW TAYLORS FERRY RD
Project: Gevurtz Subdivision: 1993-002 PARTITION PLAT Lot: 1
Project Description: Drive ground rods,bond gas piping,re-bond after re-pipe.
Contractor: CHARGED ELECTRIC LLC Owner: GEVURTZ, BERNICE R REV LIVING TR
12175 SW SUMMER CREST DR BY GEVURTZ, BERNICE R TR
TIGARD, OR 97223 7427 SW 64TH PL
PORTLAND,OR 97219
PHONE: 503-380-4364 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 08/13/2015 $56.18
Specifics:, Service or Feeder
1 ea 12%State Surcharge- 08/13/2015 $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 perm ssued • - t to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law. All work will
be d in accordance with .=.rove. • ••s. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
d ATTENTION: Oregon la =quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
2-001-0010 through OAR 952-0' •090. o y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 0 1.800.33 4.
Issued By: / 1�a / / 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:
CO TRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date: TAW
LICENSE NO. )5 E ?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 Applicat o CEIV1 FOR OFFICE USE ONLY
City of Tigard Received
1111 - g Air 1 3 2015 Date/B : p �� � ��/ ��I /ri
13125 SW Hall Blvd.,Tigard,OR 9 2t3
Phone: 503.718.2439 Fax: 50 1 r u Related Permit#:
Inspection Line: 503.639.41751.1 E I' ,,!GARU Ready Date/By: lurs: ® See Page 2 for
I It, \R I) Internet: www.tigard or.govplirl` *t I Notified Method: Supplemental Information
p t! DIIVr.DIVISION
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 13,Other: -5 re,u t..d where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑Floating buildings.
to I-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 0 Other: ['Fire pump. Dlnstallation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: I Job site address: 6 06 5p,I 1µi rods tcry re) 100HPormore. ❑"A" "E" "I-2""1-3"
City/State/ZIP: l ❑Six or more residential units. occupancy.
ty rd 'Z� Recreational vehicle parks.
❑Health-care facilities. ❑ P
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: FEE SCHEDULE
Description I Qt . I Each I Total I '
New residential single-or multi-family dwelling unit.
Subdivision: I 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 I
DESCRIPTION OF WORK i Limited energy,residential
75.00
9 T..rt ,S f`dol5� �1,A S e i c-L-1,„ (with above,m multi-family .
�� Limited energy,multi-family
a ek,e_ 1----- P ."-l_ residential(with above sq.ft.) 75.00
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70
Address:
201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 '_
City/State/Z1 P: 601 amps to 1,000 amps 301.04 '_
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 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
❑ APPLICANT I 'CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: 6.4■4h,- 1� aeL-kr-L. above service or feeder fee,
7.42 2
r _ each branch circuit
Contact name: ,, (� . ( B.Fee for branch circuits without
V service or feeder fee,first 56.18 .5-:,.(r 2
Address: ( L( S 1y�) r..,o„ 0—/ L�-y Y ( t branch circuit
City/State/ZIP: �k rp) _ LZ`1 Y Each add'1 branch circuit 7.42 2
/ Miscellaneous(service or feeder not included)
Phone:(5') 34,6?4344 I Fax::( ) Each manufactured or modular 67.84 2
Email: dwelling,service and/or feeder
. Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:ato1/4,.a � ) l t e..-t c,.. Sign or outline lighting 67.84 2
�" Signal circuit(s)or limited-energy ❑ Page 2 2
Address: 12(1-c— � ) '��v/ „s,tµ.Lt 6pLit Dr, panel,alteration,or extension.
City/State/ZIP: /e:.r,r d e ` 1-2,-1.-3 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:0 3)sta.4.244 I Fax:( )-51-2...a 5-16 Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:. �`�,.�t�(elrtc �a�.H,��,t(•ce rv--
G ° - a — Inspections for which no fee is
CCB Lie.: (i (1('5 I Electrical Lie.: (,6 5'1- I Suprv.Lic.: 53'135 specifically listed(';_hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: g
Subtotal: jp,
Print name: 544,_.....- - .(( Date: S (3 - ( ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 4,79'
Authorized signature: TOTAL PERMIT FEE: OA,F,g..,.
! This permit application expires if a permit is not obtained within 180
Print name: lye,,,.,_ fea�.►, I( Date: g -(5 --lc- days after it has been accepted as complete.
* Number of inspections allowed per permit.
L,Building.Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-46151(1I/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY:. : FEE SCHEDULE *
Fee for all residential systems combined: $75.00 Description I QS). I Each Totp1 I
�' Renewable 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:
I I 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 55226 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
❑ 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 1
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(' hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 allowe al(Enter on Page►):
(SEE OAR 918-309-0000)
* Number of inspections allowed per permit.
Check Type of Work Involved:
n Audio and Stereo Systems
Boiler Controls
Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
HVAC
n Instrumentation
n Intercom and Paging Systems
Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
l:\Building,Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
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
6906 SW TAYLORS FERRY RD, TIGARD, OR,
97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00646
David Young
Ground rods installed.
Violation Summary:
Inspector Contractor