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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2015-00850 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/19/2015 Parcel: 2S110AD90054 Jurisdiction: Tigard Site address: 14946 SW 109TH AVE Project: Canterbury Woods Condo Reconnect Subdivision: CANTERBURY WOODS CONDO Lot: 54 Project Description: Reconnect only Contractor: OWNER Owner: CAMPBELL, KRISTY N 14946 SW 109TH AVE TIGARD, OR 97224 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 1 ea Reconnect Only 10/19/2015 $67.84 Specifics: 1 ea 12%State Surcharge- 10/19/2015 $8.14 Electrical Type of Use: MF Class of Work: ALT 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 the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OA 952-001-0090. You may tarn a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: IJ� (/ `'i /I 60 CJ 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 FOR OFFICE (NE O\I.1 Received . 1O\'�‘ r1C-2O)c-00?50 City of Tigard Date/By: Permit# �jl UPI • 13125 SW Hall Blvd.,Tigard,OR 97223 view■= Phone: 503.718.2439 Fax: 503.598.1960 R EC E I .R5 /r Related Permit#: Inspection Line: 503.639.4175 Ready Date/By: JurisT p BI See Page 2 for TI G A R D Internet: www.ti ard-or. ov •otified/Method: (� g g OCT 1 Supplemental Information TYPE OF WORK _ PLAN REVIEW ❑New construction ❑Ad.' 1. 'Iteration/r u �P• �J A • D Please check all that apply(submit 2 sets of plans w/items checked). ❑ Demolition '4 Other.- l ' n t f + ❑Service or feeder 400 amps or more ❑Building over three stones. �� ._ � i���( where the available fault current ❑Marinas and boatyards. CA E ORY 0 CONSTRUCTI I N exceeds 10,000 amps at 150 volts or ❑Floating buildings. _-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ILMulti-family ❑ Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived Job#: Job site address: ❑Addition of new motor load of system. 1 • WI 1 - , .I b- 100HP or more. ❑"A" "E" "1-2",`9-3", • ix or more residential units. occupancy. City/State/ZIP: b a, J CD1 s ❑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: t _ 6 as 01 Lot#: [ Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: 1 ` 0 09 ; Ea.add'I 500 sq.ft.or portion DESCRIPTION OF WORK Limited energy,residential . 75.00 8 ' ` A ` �y (��� with above ..ft. G l Zk - 111 W 1 1 IL�1 Limited energy,multi-family 75.00 �residential(with above sq.ft.) Renewable Energy ❑ See Page 2 ❑ PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 2 Address: 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) I 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, ler panel A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 Rose Country Realty each branch circuit Contact name: B.Fee for branch circuits without 2050 Beavercreek Rd#101 IL . service or feeder fee,first Address: Oregon Citv,OR 97045 _ _ S . _ branch circuit 56.18 2 City/State/ZIP: Each add'I branch circuit 7.42 2 Phone:Ail ) gib crave, I Fax: : ' Q Each manufactured service u aeeder not included C]] Each manufactured or modular dwellin:,service and/or feeder 1111 67.84 -©14.Email: y - _ _ ._t+ Amp 4 a , ! _` t `,a Reconnect only ,■ 67.84 r ! s CONT' TOR Pump or irrigation circle 67.84 2 w Business name: Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: panel,alteration,or extension. ❑ See Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(I hr min) 66.25/hr Phone:( ) I 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.: I Electrical Lie.: I Suprv.Lie.: specifically listed(/hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: W� Print name: Date: ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Au[horiz si attire: TOTAL PERMIT FEE. 15 9 • This permit application expires if a permit is nottaained within 180 Print na e: Date: I CV 1 3l J}..7 days after it has been accepted as complete. Jill\ / • Number of inspections allowed per permit. I:\Building\Permits\E1.C_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(II/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 14946 SW 109TH AVE, TIGARD, OR, 97224 Commercial - Electrical 199 Electrical final PASS - No C of O ELC2015-00850 Jeff Grove Violation Summary: Inspector Contractor