Permit CITY OF TIGARD ELECTRICAL PERMIT
II r COMMUNITY DEVELOPMENT Permit#: ELC2015-00700
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/31/2015
Parcel: 2S104AA08900
Jurisdiction: Tigard
Site address: 12180 SW 127TH AVE
Project: ROBINSON Subdivision: BELLWOOD NO.2 Lot: 96
Project Description: Panel replacement.
Contractor: CHEROKEE ELECTRIC CO Owner: ROBINSON,JAY G BRIGITA
13019 SW BRADLEY LN 12180 SW 127TH AVE
TIGARD,OR 97224 TIGARD, OR 97223
PHONE: 503-209-9039 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 08/31/2015 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 08/31/2015 $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 a e set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a co. - -- les or direct questions to OUNC by calling 503.23 . 7 or 1.800 2.2344
Issued By: ���`�_ �i�- - • ittee 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.
1
Electrical Permit Application a t� FOR OFFICE USE ONLY
City of Tigard 141\11- Received / Permit No
�' g C " Date/B : i� Asir IS= Z ,
III 13125 SW Hall Blvd.,Tigard,OR Plan Review
Phone: 503.718.2439 Fax: 503.5'.. 60 Q�5 Date/By: Other Permit:
I t r t Inspection Line: 503.639.4175 q 1 Date Ready/By: luris: VI See Page 2 for
Internet: www.tigard-or.gov Q G i7 Notified/Method: "I'' Supplemental Information
TYPE OF WORK,. OV,�•l•A`kr PLAN REVIEW
❑New construction Addition/alterat
tr��ee Please check all that apply(submit 2 sets of plans w/items checked below):
❑Demolition ❑Other:
,. ❑Service or feeder 400 amps or more ❑Building over three stories.
°'3 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
El 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building 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 system.
❑Addition of new motor load of ❑"A","E","l-2","I-3",
p� ) r`
100HP or more. occupancy.
Job no.: Job site address:
1,,/O D 5 L �� ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: 7.--/.5' a,�—� OQ 77.2,2- 0 Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: .Obi i4 so el ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. I Total I *
f /1- New residential single-or multi-family dwelling unit.
A l M,(4,f-
t,r y a/wye /2.1( Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family
pp`a� F' e-r&( Ac.. _ / x / residential(with above sq.ft.) 75.00 2
tom/ ^ � 1 Renewable Energy ❑ See Page 2
/.L,7 E /n I h bl2�.R ptsr,°t✓/ Services or feeders installation,alteration,and/or relocation
l M PROPERTY OWNER I ❑ TENANT 200 amps or less / 100.70 al,to 2
201 amps to 400 amps 133.56 2
Name: -1-4." R b I a 5 on 401 amps to 600 amps 200.34 2
Address: J 601 amps to 1,000 amps 301.04 2
�z.( s/0 5� /27 Over 1,000 amps or volts 552.26 2
City/State/ZIP: g a�C 8k 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-new,alteration,or extension,per panel
M APPLICANT l ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
Business name: e,�j k�� g(e f 1-l�c_ each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name: service or feeder fee,first
O t/t Sc,r/ v(n e,r branch circuit 56.18 2
Address: j' O/9 5 G41 g� Ley Le. Each add'I branch circuit 7.42 2
City/State/ZIP: T* 3 a„rte 0 11 4 2 �} Miscellaneous(service or feeder not included)
`� / Each manufactured or modular
_ 67.84 2
Phone:(S 03) ..z09.— q O e Fax: :( ) dwelling,service and/or feeder
- �, Reconnect only 67.84 2
E-mail: C,\�r'O ke_e.-e✓te_ C.t- ' Off` a.rtert.l f • �Jr�^ Pump or irrigation circle 67.84 2
^n / CONTRACTOR)/ ■ Sign or outline lighting 67.84 2
Business name: a a—D`me_ 0,,j-,, Signal circuit(s)or limited energy See
!l panel,alteration,or extension. Page 2 2
Address: /30(1 s•(,) ,B e_,7 L_ Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
City/State/ZIP: a r�, Q c _2_ Investigation(1 hr min) , 66.25/hr
Phone:(5" 3)Dq'- 7039 Fax:( 1 ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.:3.5-6 8'( Electrical Lic.: 3 -/a,7 c' Suprv.Lic.: , to S specifically listed(%=hr min)
Z . ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: /pv. 70
Print name: 'Fnn SC_r/`1/ Lo r- Date: e J(_/� Plan review(25%of permit fee): —
J State surcharge(12%of permit fee): /1.-
Authorized signature: TOTAL PERMIT FEE: -0/� -)g_.......41,.....t....... ........
Print name: Date: This permit application expires if a permit is not obtained within 180
O`f S-r rt'vet ter` g'-3 j �S� days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PennitApp_ELR_ERE.dac Rev 05/21/2013 440-4615TO1/05/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 Qty. I Fee 1 Total 1 •
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
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
❑ Heating,Ventilation and Air Conditioning OAR 918-309-0040)
System* Solar generation systems in excess of 25 kva:
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
charged at an hourly(I hr min) 6625/hr I•
Inspections for which no fee is 90.00/hr
specifically listed(%l hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
' Number of inspections allowed per permit.
❑ 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
I\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013
1
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
12180 SW 127TH AVE, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00700
Jeff Grove
Violation Summary:
Inspector Contractor