Permit n CITY OF TIGARD ELECTRICAL PERMIT
11111 1 • COMMUNITY DEVELOPMENT Permit#: ELC2015-00762
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/22/2015
Parcel: 1 S125DD08700
Jurisdiction: Tigard
Site address: 9690 SW VENTURA CT
Project: Pangborn Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 95
Project Description: 200 amp panel change
Contractor: HORTON ELECTRIC Owner: PANGBORN, JEFFREY L&CANDACE L
11266 SE 21ST AVE SUITE 107 9690 SW VENTURA CT
MILWAUKIE, OR 97222 PORTLAND, OR 97223
PHONE: 503-267-2797 PHONE: 503 807-6064
FAX: 503-659-8864
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 09/22/2015 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 09/22/2015 $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. ATT • • • • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-•610 through OAR 95 r01- . ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 11.00.332. 44.
Issue. By: i/■ .I -. t Permittee Signature: 11.4 L;/ /
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' e c J Date:
LICENSE NO. 7/(-7F 7
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 Appli t, 1 1 11: 11 11 I -.1 t l N ,
City of Tigard '" ��� Received 9 Bs 1 �� Per mit q: E! „AO/
7O Date/B
lig 13125 SW Flail Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 50� 9�21 2 u 7 DateB : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: hris: ® See Page 2 for
I K., \I.1> Internet: www.tigard-or.gov Notified/Method: Supplemental Information
116AKU
4' {r'- '.II PLAN REVIEW
1 I i . 11 L. i M. I ft1�tY Please check all that apply(submit 2 sets of plans w/items checked):
❑New construction ®Ad. t r t
El Demolition ❑Other: ❑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.
® 1-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 ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:9690 SW Ventura Ct 100H13 or more ❑"A "E "1-2^,°t-3 ,
City/State/ZIP:Tigard,Oregon 97223
0 Six or more residential units. ❑ vehicle parks
❑Health-care facilities.
Suite/bldg./apt.#: Project name:Jeff Pangborn ❑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: 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 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
200 amp panel change (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 1 ❑ See Page 2
® PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name:Jeff Pangborn 200 amps or less 1 100.70 100.70 2
Address:9690 SW Ventura Ct 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,Oregon 97223 601 amps to 1,000 amps 301.04 2
Phone:(503)807-6064 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 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:Horton Electric Co. above service or feeder fee,
7.42 2
each branch circuit
Contact name:Jay Horton B.Fee for branch circuits without
Address: 11266 SE 21st Ave Suite 107 branch circuit fee,first 56.18 2
branch circuit
City/State/ZIP:Milwaukie,Oregon 97222 Each add'l branch circuit 7.42 - 2
Miscellaneous(service or feeder not included)
Phone:(503)267-2797 Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: hortonJay @yahoo.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Horton Electric Co. Sign or outline lighting 67.84 2
>< Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: 11266 SE 21 Ave Suite 107 panel,alteration,or extension.
City/State/ZIP:Milwaukie,Oregon 97222 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)267-2797 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:hortonJay @yahoo.com y Industrial plant(1 hr min) 78.18/hr
■ \t1 ,tr Inspections for which no fee is 90-00/hr
CCB Lic.: 818 ',�I ti'l Electrical Lic.: 3-1 IC ik% Suprv.Lic.: 4497 5 OW specifically listed(V2 hr min) -
1 ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 100.70
Print name: Jay Horton Date: 9/21/2015 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 12.08
TOTAL PERMIT FEE: 112.78
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(i1/05/COM/WEB