Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2015-00909
13125 SW Hall Blvd.,Tigard OR 97223 503.718 Date Issued: 11/12/2015
718 2439
TIGARD Parcel: 1 S134CB01800
Jurisdiction: Tigard
Site address: 12130 SW SUMMER ST
Project: Wallenius Subdivision: SUMMER HILLS PARK Lot: 21
Project Description: Reconnect only.
Contractor: OWNER Owner: THREE FIVE PROJECT LLC
JEFF WALLENIUS BY WALLENIUS, JEFF J
9230 S GOOD LN 9230 S GOOD LN
CANBY, OR 97013 CANBY, OR 97013
PHONE: 360-433-5436 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 11/12/2015 $67.84
Specifics:
1 ea 12%State Surcharge- 11/12/2015 $8 14
Electrical
Type of Use: SF
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 O'' =� 09I. You may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 orrl1/800 33222344 ,� /
Issued By: - Permittee Signature: L / .�T/`!"Z-/l ��e7,v
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 ��
s.. Received City of Tigard f
Date/By: �/z 'y�✓�y�/Q/��If Permit# /C�/s�G'q0�`
'I 13125 SW Hall Blvd.,Tigard,OR 97223 NOV V 1 2 2015 Plan Review / Related Permit#:
z Phone: 503.718 2439 Fax: 503.598- DateBy.
Inspection Line: 503.639.4175 r TIGARD Ready Date/By _furls El See Page 2 for
TiGARD Internet: www.tigard-or.gov �U1L®1NG DIVISio Nohfied/Method Supplemental Information
'tl •Icasc check all that apply(submit 2 sets of plans whtems checked).
TYPE OF WORK Service or feeder 400 amps or more Building over three stones.
New construction Addition/alteration/replacement where the available fault current Marinas and boatyards.
Demolition Other: exceeds 10,000 amps at 150 volts or Floating buildings.
less to ground,or exceeds 14,000 Commercial-use agricultural
CATEGORY OF CONSTRUCTION amps for all other installations. buildings.
1-and 2-family dwelling Commercial/industrial Accessory building Fire pump. Installation of 150 KVA or
Multi-family Master builder Other: Emergency system. larger separately derived system
Addition of new motor load of
JOB SITE INFORMATION AND LOCATION 100HP or more occupancy.
ob#: Job site address: �' J 3�? oli ((rf7M r' Six or more residential units Recreational vehicle parks.
-� Health-care facilities Supply voltage for more than
ity/State/'LIP: 7264/2,0 6,j Z ',7 2-2--3 hazardous locations. 600 volts nominal.
Service or feeder 600 amps or more.
Suite/bldg./apt.#: Project name: FEE SCHEDULE
-'Toss street/directions to job site: jZ/ 5-1-7 >eseription Qty. I Each r Total *
I'ew residential single-or multi-family dwelling unit.
neludes attached garage.
ubdivision: Lot#: 1,000 sq ft or less 168 54 • 4
I'i,add'1 500 sq.ft.or portion 33 92 1
'ax map/parcel#: i invited energy,residential
DESCRIPTION OF WORK __ invit d energy,m
ulti-famdy
75.00 2
IYiPr7�t�- /A/J7---)E4------77 G,n� residential(with above sq.ft.)
I enewable Energy See Page 2
PROPERTY OWNER TENANT 'ervices or feeders installation,alteration,and/or relocation
-,-- r 00 amps or less 100.70 2
tame: d c `GIB...l-f�,G 1 i i,1 '01 amps to 400 amps 133 56 2
ddress: ',L 3() S'. & Cif2 4.A/ 01 amps to 600 amps 200.34 2
ity/State/ZIP: (" try/ 07(7 c)7 0 4 ' 01 amps to 1,000 amps 301.04 2
'hone:(340) 1433-,s—y? ..., Jax:( ) ver 1,000 amps or volts 55226 2
'emporary services or feeders installation,alteration,and/or
f relocation
;mail: lee h'te,pryit-c-C:T 4 Likti to . c cr✓t-1
ll wner installation:This installation is being made do property that i own which is not 000 amps or less 59.36 i
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. r01 amps to 400 amps 125 O8 2
wncr s !..,n• 01 amps to 599 amps _ 168 54 _ 2
rip,1t_� Branch circuits—new,alteration,or extension,per panel
Date: 1,1 I it } . A Fee fin branch circuits with
APPLIC I CONTACT PERSON above service or feeder fee,each 7.42 2
branch circuit
1 usiness name: a.Fee for branch circuits without
service or feeder fee.first branch 5618 2
ontact name: circuit
\ddress: Each add'I branch circuit 7 42 2
City/State/ZIP: : iscellaneous(service or feeder not included)
Each manufactured or modular 67 84 2
Phone:( ) (Fax: :( ) .well mg,service and/or feeder
•
I'econnect only 67.84 '( 2
mail:
imp or irrigation circle 67.84 2
CONTRACTOR ign or outline lighting 67.84 2
I usiness name: ignal circurt(s)or limited-energy See Page 2 2
i.anel,alteration,or extension.
Address: Each additional inspection over allowable in any of the above
ity/Stale/ZIP: dditional inspection(1 hr min) 66 25/hr
nvestigation(I hr mm) 90 00/hr
'hone:( ) Fax:( )
Industrial plant(1 hr mm) 78 18/hr
Email: Inspections for which no fee is
90.00/hr
specifically listed(V2 hr min)
CB Lie.: Electrical Lie.: Suprv.Lie.: ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: s I sy
Plan Review Required(25%of permit fee):
I tint name: Dale:
State surcharge(12%of permit fee): , //
TOTAL PERMIT FEE: 'S 5..-
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
PLAN REVIEW
I dtuddme\Pemas\F.LC PermitAno ELR ERE doc Rev 06/17/2015