Permit CITY OF TIGARD ELECTRICAL PERMIT
I COMMUNITY DEVELOPMENT Permit#: ELC2015-00760
T R ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/21/2015
Parcel: 2S 114BA00800
Jurisdiction: Tigard
Site address: 9965 SW SERENA WAY
Project: HUD Subdivision: PICKS LANDING NO.2 Lot: 131
Project Description: Reconnect only.
Contractor: Owner: USA SECRETARY OF HOUSING &URBAN DEVE
BY WELLS FARGO BANK
3476 STATEVIEW BLVD
FORT MILL, SC 29715
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 09/21/2015 $67.84
Specifics:
1 ea 12%State Surcharge- 09/21/2015 $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 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 e ru- .dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a cop • le rules•r direct questions to OUNC by calling/503. 87 or 1.80 . .2344.
Issued By: �� _ / Permittee Signature:
/I
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 i1V FOR OFFI(F. l SF.O\I 1
City of Tigard (r)//)
City f g �� Permit#: _ _p
13125 SW Hall Blvd.,Tigard,OR r�o�5 Plan Review Related Permit#:
Phone: 503.718.2439 Fax: 503.598.1960 q N. 1. Date/Ft :
Inspection Line: 503.639.4175 GQ P ((111 Ready Date/By: r ® See Page 2 for
T I G A R D Internet: www.tigard-or.gov ���,,Vi O Notified/Method: -T"7"c. Supplemental Information
TYPE OF WrI `J0 0 PLAN REVIEW
Please check all that a Iv(submit 2 sets of plans w/items checked
❑New construction ❑Addition/alteraUt ti ent l0 P Y
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition El Other: 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:9965 SW Serena Way I00HP or more. ❑"A"• F"• 1-2 "1-3",
❑Six or more residential units. occupancy.
City/State/ZIP:Tigard,OR 97224 ❑Ilealth-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:HUD-Barnhart ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: west on Durham to Serena Way FEE SCHEDULE
Description l Qty. l Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision:Pick's Landing Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'l 500 sq.ft.or portion 33.92 l
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
reconnect only
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
® PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: HUD-PKMG 200 amps or less 100.70 2
Address: 10 Canal Street Suite 232 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Bristol,PA 19007 601 amps to 1,0(x)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 2(X)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 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: Monica and Jeff Barnhart B.Fee for branch circuits without
Address:29237 SW Tami Loop#187 bran
service or uit fee,firs 56.18 2
City/State/ZIP:Wilsonville,OR 97070 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)509-0222 Fax: :( ) Each manufactured or modular
67.84 2
na mail.com dwelling,service and/or feeder
Email: monica.barnhart
g Reconnect only 1 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 ❑ Page 2 2
Address: 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(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 00/hr
CCB Lie.: Electrical Lie.: Suprv. Lie.: specifically listed CAN-min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if s permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
L\I3uitding.Perrnits'ELC PcnnitApp ELR_ERE.doc Rev 06'17/2015 440-46151(11/05/COM/WEB