Permit A. ; If CITY OF TIGARD ELECTRICAL PERMIT
:4iya
g COMMUNITY DEVELOPMENT Permit#: ELC2015 00951
Date Issued: 12/02/2015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
#
Parcel: 25111 BC01700
Jurisdiction: Tigard
Site address: 10265 SW VIEW TER
Project: Stack Subdivision: GREENBRIER Lot: 1
Project Description: (1)branch circuit for new gas fireplace insert.
Contractor: OWNER Owner: STACK REVOCABLE TRUST
RICHARD STACK BY STACK, RICHARD W& JUDITH C
10265 SW VIEW TERRACE 10265 SW VIEW TER
TIGARD, OR 97224 TIGARD, OR 97224
PHONE: 503-639-4537 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 12/02/2015 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/02/2015 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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: _0 egon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rul are set forth in OAR
952-001-0010 thr gh OA 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503 2or 1.80 32. 44.
Issued By: • �!9Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property //wwhhichls me d f;'---='tease or rent.
OWNER'S SIGNATURE #1� i/�.,;0'" ' Date: /0-//5
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 A lica ' `ice A_ ��. oR `E � '
CEIvEp . EOR,OFFICE:[ISE ONtiY A
ofTigard Received ^/ /
IV-
City g Date/B : /0`�1 S Permit#: �{j��j'�(,�' 4,�/
tt 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.SE1�60 215 Date/B : Related Permit#:
TIGAInspection Line: 503.639.4175 Ready Date/By: inns a See Page 2 for
® www ttgard Or gov Notified/Method: Supplemental Information
Internet:
IG,
_,; ® 8. tit ;Li)V Oil it4 .A _ 1: PLAN.REVIEW. E,' , , ,n:„ - .
❑New construction Addition a era 10 UrC laE rl�g Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current
0 Marinas and boatyards.
`ll =,CATEGORY OF'CONSTRUCTION "!1:7;44,..,,:.;:-,:::;:;-.: exceeds 10,000 amps at 150 volts or 0 Floating buildings.
I-and 2-familydwelling ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
® ❑ Commercial/industrial amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑Other: 0 Firetun
p p. ❑Installation of]50 KVA or
g:. - '5JOB-SITE ,INFORMATION.AND'LOCATION" .;,,, '"ti El Emergency system larger separately derived
❑Addition of new motor load of system.
Job#: 100 Job site address: 10265 sw view terrace l0OHP or more. ❑"A","E","I-z","t-3",
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Gas Insert El Hazardous locations. El Supply voltage for more than
❑Service or feeder 600 amps or inure. 600 volts nominal.
Cross street/directions to job site: 103 rd =a / ,,:' .'FEE`SCHEDULE *1,Aa,
Description 1 Qty. I Each 1 Total 1 *
New residential single-or multi-family dwelling unit.
Subdivision:Greenbrier Lot#: 1 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:2S111BC 01700 Ea.add'1 500 sq.ft.or portion 33.92 1
' ,1 , DESCIRIPTI.ON=OF_=WORK, ' ` -_'.'1''''1`77.' Limited energy,residential 75.00 2
Gas fireplace insert install (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
,. Renewable Energy Ill See Page 2
;
-�®,!PROPERTY:OWNERS ', 0,,TENANT,-;ty, ,a"', Services or feeders installation,alteration,and/or relocation
Name:Richard Stack .--' 200 amps or less 100.70 2
Address: 10265 SW View Terrace 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,OR 97224
601 amps to 1,000 amps 301.04 2
Phone:(503)639-4537 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 be' g made on property that I own which is not 200 amps or less 59.36 t
intended for sale,lease,r- t,o>;ex n qe(acc,...'i/to O' 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature:/x ,�� Date: 401 amps to 599 amps 168.54 2
:: �t t,)®,/APL ,-A - _ • -'. a-CONTACT PE32SON - 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: B.Fee for branch circuits without
service or feeder fee,first 1 56.18
Address: branch circuit 56.18 2
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
a t):: . .4 ,j' .CONTRACTOR:'":,,, x. ., . .=i 3. Pump or irrigation circle 67.84 2
Business name: no N L(e.., Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. El See Page 2 2
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 90.00/hr
CCB Lic.: Electrical Lic.: Suprv. Lic.: specifically listed('/2 hr min)
4',r,."_ ''''ELECTRICA'L''PERMIT FETES,'__::;1. :W:,:
Suprv. Electrician signature,required: Subtotal: 56.18
Print name: Date: ❑Plan Review Required(25%of permit fee): 14.05
State surcharge(12%of permit fee): 6.74 t
Authorized signature: TOTAL PERMIT FEE: �6 43--
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 doe Rev 06/17/2015 440-4615T(I I/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
10265 SW VIEW TER, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00951
David Young
Violation Summary:
Inspector Contractor