Permit CITY OF TIGARD ELECTRICAL PERMIT
it • COMMUNITY DEVELOPMENT Permit#: ELC201500721
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/16/2015
Parcel: 1 S133DC04600
Jurisdiction: Tigard
Site address: 11558 SW 133RD PL
Project: BANICH Subdivision: BRITTANY SQUARE NO.1 Lot: 4
Project Description: Reconnect only.
Contractor: NOT REQUIRED Owner: BANICH, MARYANNE
11558 SW 133RD PL
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 09/08/2015 $67.84
Specifics:
1 ea 12%State Surcharge- 09/08/2015 $8.14
Electrical
Type of Use: SF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
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 ac • •- - 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- ION: Oregon law -.wires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0'10 through OAR 952 r, -00"0 You may obtain a copy of the rules or direct questions to OUNC by calling 5.1987 or 1.800.33332.22 44.
Issued Permittee Signal re: .1'47151 4.vt
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 1 trill ui•ric is 1-tit:()Nil
City of Tigard DateeiB d A
Plan Review 1477 TIMINIMINIMIll
1111111 13125 SW Hall Blvd.,Tigard,OR 97223
= Phone: 503.718.2439 Fax: 503.598.1960 Date/13 : Related Permit I.
Inspection Line: 503.639.4175 Ready Date/By: tur1S _ H See Page 2 for
1 I(l A R l) Internet: www.tigard-or.gov Notified/Method: /c.-C> Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑ Demolition 1:2]Other: RECONNECT ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings
® I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ Multi-family Master builder Other: amps for all other installations. buildings.
y ❑ ❑ ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address: 1 1558 SW 133RD PL ❑Additioo of new motor load of system.
IOOHP or more. ❑"A"."E"."t-2"."1-3"
City/State/ZIP:TIGARD,OR 97233 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: 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 Qty. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision:BRITTANY SQUARE Lot#:4 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:R1298660 Ea.add'I 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
POWER OFF MORE THAN 6 MONTHS AND IS REQUIRED BY ELECTRIC
(with above sq.ft.) 75.00 2
Limited energy,multi-family
75.00 2
CO TO HAVE IT INSPECTED BEFORE THEY WILL RESTORE POWER residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER () ,,` I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: )—I r-119._y (lu1,J G. I cj^t'1 o t C-I'{ 200 amps or less 100.70 2
Address: )l 55 S �1.::% (33
fyP 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Coo(2.T- 012. 9 7%C')-3
601 amps to 1,000 amps 301.04 2
Phone:( ) 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 1 25.08 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:ROSE COUNTRY REALTY above service or feeder fee,
7.42 2
each branch circuit
Contact name:ANNIE WRUCKE B.Fee for branch circuits without
Address:2050 BEAVERCREEK RD#101 branch circuit fee,first 56.18 2
branch circuit
City/State/ZIP:OREGON CITY OR 97045 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(971)570-2216 Fax: :(503)200-1298 Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email:ASSISTANT @OREGONREO.COM Reconnect only I 67.84 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(I hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed(V,hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal: 67.84
Print name: , Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 8.14
�1' TOTAL PERMIT FEE: 75.98
Authorized signat LLQ....
This permit application expires if a permit is not obtained within 180
Print name: ANNIE WRUCKE Date: 8.11.15 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-4615T(1I/05/COM/WEB
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
11558 SW 133RD PL, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00721
Jeff Grove
Violation Summary:
Inspector Contractor