Permit CITY OF TIGARD ELECTRICAL PERMIT
Permit#: ELC2015-00840
COMMUNITY DEVELOPMENT
Date Issued: 10/15/2015
TIGARD 13125 SW Hall Blvd,Tigard OR 97223 503 718 2439 Parcel: 1S135CD02500
Jurisdiction: Tigard
Site address: 11835 SW 95TH AVE
Project. Kent Subdivision::HERS ADDITION TO GREENBURG HE Lot: 8
Project Description: Complete rewire with separate meters for house and shop. ((1)400 amp service,(1)sub feeder&(13)branch
circuits)
Contractor: OWNER Owner: KENT, ROBERT&ASH LI
ROBERT KENT 13155 SW 124TH AVE
13155 SW 124TH AVE TIGARD, OR 97223
TIGARD, OR 97223
PHONE 503-820-8769
HONE 503-820-8769
FAX
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 10/15/2015 $100 70
Specifics: amps or less
1 ea Services or Feeders-201 to 10/15/2015 $133.56
Type of Use: SF 400 amps
Class of Work: ALT 13 crt Branch Circuits w/Purchase 10/15/2015 $96 46
Service or Feeder
Type of Const: 1 ea 12%State Surcharge- 10/15/2015 $39 69
Occupancy Grp: Electrical
Total $370 41
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 in accordanc ith 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
d s ATTENTION Orego• 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 9 • 001-096 You may obtain a c••y of the rules or direct questions to OUNC by calling 503 232 r 1 800 332 2344
, ,• g
ssued B y: k Permittee Signature: V
OWNER INSTALLATION ONLY
The installation is being made on pro••- own w h is not intended for sale,lease or rent
OWNER'S SIGNATURE , Date: /O//5-4--
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 Applicati. OR F OFFICE USE ONLv
§� Cl g
Of Tigard C V Received
Permit#
of Date/B Q
'4 13125 SW Hall Blvd,Tigard,OR 97223 Plan Review
III
Phone: 503 718 2439 Fax: 503 598.19 DateB Related Permit 4
i Inspection Line 503.639 4175 IJ � 1 5 l i�l
TI GARD p Ready Date/By Jana See Page 2 for
e.a Internet. www tigard-or gov Notified/Method Supplemental Information
i TYEE O ® ( TI." f PLAN,_... 1 ::
<�,� p _£��,� t ' °; .:c� ,REVIEW,.'?ii`; '3::i,-`.
❑New construction ig Additiotl �ON94 ��A Please check all that apply(submit 2 sets of plans w/items checked)
❑ Demolition ❑ Other: ❑Service or feeder 400 amps or more ❑Building over three stories
_ where the available fault current ❑Marinas and boatyards
A/' . ;'° 3 _ -"'"CATEGORT�OF CONSTRIJCT1 ,_, `< ',. ,111 exceeds 10,000 amps at 150 volts or ❑Floating buildings
'® I-and 2-family dwelling ❑Commercial/industrial ET 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
i t; 'r,•' ,;y,�S,o®BSITE INFORMATIONv=AN'D LOCATION;-':`:':-l;>' :,.;r_;. 0 Emergency system larger separately derived
Job#: Job site address: _ ^ ❑Addition of new motor load of system
/83r5u9S JG.. I00HPormore ❑"A","E","1-2","1-3",
City/State/ZIP: 7',`a- O S 9 722.3 ❑Six or more residential units Recreational❑Health-care facilities ❑Recreational vehwle parks
Suite/bldg./apt.#: /Project name: ❑Hazardous locations
0 Supply voltage for more than
❑Service or feeder 600 amps or more 600 volts nominal
Cross street/directions to job site: Gre _- be- j-- � . S� t,9 ;° _;'FEE SCHEDULE':
Description 1 Qty. 1 Each I Total 1 *
m— 5.5.-211-C New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 Tax map/parcel#: (s/ 3 s'G 0 O Z S'OC or n 33 92 I
ir .x. . ,
� " DESCRIPTION"OF MOW' '
sq less 4
Ea a 500 sq or portion
�� -•••• " '° Limited energy,residential
(with above sq ft) 75 00 2
Gc�pi e 1. .1"c_ ta/ Se Pe-c'}•` ,-014.7<e...-5. Limited energy,multi-family
c ����� �,.� ����
residential(with above sq ) 7500 2
,,,, Renewable Energy ❑ See Page 2
:..
;��' .;PROPERTY OWNER`;-;�� 's ��:;�°�TENANTV Services or feeders installation,alteration,and/or relocation
Name: Rd file j^ 1.„,,c—i_— 200 amps or less r / 100 70 `(, rp 2
Address: �� 201 amps to 400 amps / 133 56 /;3./(o 2
3l `�� S�� 2 �� �vc 401 amps to 600 amps 200 34 2
City/State/ZIP: „�/ O R 9 7.2 2 7' 601 amps to 1,000 amps 301 04 2
Phone:(,D, ) )2 Q 6) (:„ Fax:( ) Over 1,000 amps or volts 552 26 2
_ Temporary services or feeders installation,alteration,and/or
Email: g>06,,,_1.G a� c 4 4'0 dtl rt..-c..7- evM relocation
Owner installation:This installation is being m e on property that i own which is not 200 amps or less 59 36 1
intended for sale, lea r exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125 08 2
Owner signature: �- .f-� Date:' 401 amps to 599 amps 168 54 2
E; /--4°wq°t- Branch circuits—new,alteration,or extension, ter panel
-'' a PLICANT'; lit'' :r 4--CONTACT PE O'''' A Fee for branch circuits with P
Business name: above service or feeder fee, /3 7 42 qb,yb 2
each branch circuit J
Contact name: B Fee for branch circuits without
Address: service or feeder fee,first 56 18 2
branch circuit
City/State/ZIP: Each add'!branch circuit 7 42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67 84 2
dwelling,service and/or feeder
Email: Reconnect only 67 84 2
i:.•�,'"r. "- ;,;^.,. :,. CONTRAC,T„OR ;''„E "aa-,,,,f4„-.. . Pump or irrigation circle 67 84 2
Business name: 0 LC 1i1._) -/42-- Sign or outline lighting 67 84 2
Address: Signal circuit(s)or limited-energy ❑ 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(1 hr min) 90 00/hr
-
Email: Industrial plant(i hr min) 7818/hr
Inspections for which no fee is 90 00/hr
CCB Lic.: Electrical Lic.: Suprv. Lie.: specifically listed(V2 hr min)
:- 47
ELECTRICAL PERMIT FEES 7 .5-....5o,:. Tv-
Suprv. Electrician signature,required: Subtotal: e3413,43.E /
Print name: Date: 0 Plan Review Required(25%of permit fee): . .3?_44
- State surcharge(12%of permit fee): F� r7
Authorized signature:
TOTAL PERMIT FEE: G
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete. �} 70.'0
* Number of inspections allowed per permit 3
I\Budding\Permits\ELCPermiiApp_ELR_ERE doc Rev 06/17/2015 440-461 5T(11/05/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
11835 SW 95TH AVE, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00840
Herb Stabenow
Violation Summary:
Inspector Contractor