Permit (81) CITY O F TIG ARD ELECTRICAL PERMIT
q
COMMUNITY DEVELOPMENT Permit#: ELC2016-00079
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/03/2016
Parcel: 2S103CD00700
Jurisdiction: Tigard
Site address: 11555 SW FAIRVIEW LN
Project: SUNDANCE INVESTMENTS LLC Subdivision: HOLLYTREE Lot: 2
Project Description: Modifying(6)existing branch circuits,adding(3)new branch circuits,and installing(1)branch circuit for house
grounding.
Contractor: DREAMHOUSE ELECTRIC LLC Owner: SUNDANCE INVESTMENTS LLC
221 SW MOONRIDGE PL 17420 SW 110TH AVE
PORTLAND, OR 97225 TUALATIN, OR 97062
PHONE: 503-519-6711 PHONE:
FAX: 503-648-9723
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo/Purchase 02/03/2016 $122.96
Specifics: Service or Feeder
1 ea 12%State Surcharge- 02/03/2016 $14.76
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $137.72
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Special Co es and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of suan e, or if work is suspended for m e the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificati nter. Those r fo h in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the direct questions to OUNC by calling 503.23 . 987 or 1.800.33 . 4.
Issued By: Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
q (�
Electrical Permit Application l
�" Received
City of Tigard d ,o Date/By:: Permit#:
13125 SW Hall Blvd.,Tigard,OR 97229$ Plan Review r
Phone: 503.718.2439 Fax: 503.598.1960 ��� Date/B : Related Permit#: P J
Inspection Line: 503.639.4175 L�� r Ready Date/By: Juns ® See Page 2 for
Internet: www.tigard-or.gov ` J �1 Notified/Method: Supplemental Information
TYPE OF WORK. ,% i PLAN REVIEW
❑New construction ®Add ition/alterati onNh�pla ty .. Please check all that apply(submit 2 sets of plans w/items checked):
it ❑Service or feeder 400 amps ormore [I
Building over three stories.
El Demolition E]Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® I-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: 11555 SW FAIRVIEW LANE IOOHP or more. ❑"A","E","1-2","1-3
City/State/ZIP:TIGARD,OREGON 97224 ❑Six It more residential units. ❑Recreational vehicle arks.
❑Healthcare facilities. P
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: 115TH FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: ,-}-�1 T2C-<— Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: �? i (_ L tr� iv G1 l: l
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
71 1 J O 1 ttV /t G t fGU t { S (with above s .ft.
1. G. Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Ener ❑ See Page 2
PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: tj tr, J��lv�c -I 1.1 Ve L-r ire rJn S LLL 200 amps or less 100.70 2
Address: 1 '742c 2 S t ' `\r I^ 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: TLA Int%\I t'rJ (,1 IZ L2 601 amps to 1,000 amps 301.04 2
Phone: Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: '-� ^hS �h�r f�+ % - C o 1-VN C S 1 • N t 1 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
XV—PLICANT ❑ CONTACT PERSON Branch circuits–new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: (,�1�+ l�1vt L' TJq V e,;.T 0�\C l+l` S L L( above service or feeder fee, 7.42 2
each branch circuit
Contact name: S(C} B.Fee for branch circuits without
Address: 4 ) \TL, service or feeder fee,first ' 56.18 U 2
1 Z �,1 1 o p v r� branch circuit �J
Each add'I branch circuit !f 7.42 2
City/State/ZIP: y Ll�l_h1 ) �.f C) Z l Li 6, Z- Miscellaneous service or feeder no included
Phone:(JV�) �;�^ 7_3 3 Fax: :( ) Each manufactured or modular
1_
dwelling,service and/or feeder 67.84 2
Email: -�MS •,�� ,.iS 4� c_ C. T .rc T Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: �Y.0VSign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 14_N 5LJ .,P ` panel,alteration,or extension. E] See Page 2 2
�
City/State/ZIP: _ Each additional inspection over allowable in an of the above
�a� Additional inspection(1 hr min) 66.25/hr
Phone:(%13) Fax:(50-3) 6 ''y3 Investigation(I hr min) 90.00/hr
Email: - vIndustrial plant(I hr min) 78.18/hr
t0V'^ Inspections for which no fee is
90.00/hr
CCB Lic.: Electrical Lic C prv. LiC.: �S specifically listed(V:hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal: ,(;'
Print name: C Dale: ❑Plan Review Required(25%of permit fee): �"
State surcharge(12%of permit fee): ��. 70
Authorized signature: ,^-' TOTAL PERMIT FEE: j
\ j/►� r This permit application expires if a permit is not obtained within 180
Print name: JCv 7`T l t ,,jam( Date: f 1 1 days after it has been accepted as complete.
• Number of inspections allowed per permit.
lABuilding\'ermits\ELC_PermitApp_ELR_ERE.doc Rev06/17/2015 4404615T(11/05/COM/WEB