Permit CITY OF TIGARDr en ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permitil: ELC2016-00019
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/12/2016
Parcel: 1 S133DD12900
Jurisdiction: Tigard
Site address: 11849 SW 126TH PL
Project: 11849 SW 126th Ave.Replace Service due to Fire Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 166
Project Description: Replace service per PGE location after fire.2/19/16,REPRINTED to add(1)service&(16)branch circuits.
Contractor: SQUIRES ELECTRIC Owner: COURSOLLE,JEREMY M&NANCY B
657 SE YAMHILL ST 11849 SW 126TH PL
PORTLAND, OR 97214 TIGARD, OR 97223
PHONE: 503-252-1609 PHONE:
FAX: 503-253-5831
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 01/12/2016 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 01/12/2016 $12.08
Type of Use: SF Electrical
Class of Work: ALT 1 ea Services or Feeders-200 02/29/2016 $100.70
amps or less
Type of Const: 16 crt Branch Circuits w/Purchase 02/29/2016 $118.72
Occupancy Grp: Service or Feeder
0 ea 12%State Surcharge- 02/29/2016 $26.33
Electrical
Total $358.53
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 acc ce w pproved 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. ATTE ION: Oregon la requires you to follow the rules adopted by the Oregon Hier. Those rules ares set forth in OAR
952-001LOthrough OAR 952-00 -0 o may obtain a copy of the rules or direct questions to NC by callin 987 or 1.800.332. 44.
Issue Permittee Sign
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 A lice '
IoRewceivcd
City of Tigard VE Aatell3 ; o� �(� Permit,Y:
ME
13125 SW Hall Blvd.,Tigard,OR 97 3 Plan Review
Phone: 503.718.2439 Fax: 503.598Fg@ 2 5 2016 Dale/By; Related Permit 4:
Inspection Line: 503.639.4175 Ready Date/By: Juri:: O See Page 2 for
Internet: www.tigard-or.gov C1?1/�C Notifiedimethod: S plemental Information
OF
T Rn
❑New construction ®Add ition/alteration/reply ement Please check all that apply(submit 1 sets of pia w/items checked):
❑Service or feeder 400 amps or more ❑Bu Iding over three stories.
❑Demolition Q Other: where the available fault current ❑M ' as and boatyards.
exceeds 10,000 amps at 150 volts or ❑Ft ting buildings,
1-and 2-family dwelling ❑Commercial/industrial Accessory building less to ground,or exceeds 14,000 ❑C me,cial-use agricultural
amps for all other installations. bu dings.
❑Multi-family ❑Master builder Other: [l Fire pump. ❑1 dation of 150 KVA or
❑Emergency system. lar u separately derived
❑Addition of new motor load of sy em.
Job#: Job site address:111849 SW 126't Pl. I OOHP or more. ❑"A,"E, l-z","►-3^,
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. Cc ancy.
❑Health-care facilities. ❑R eational vehicle parks.
Suite/bldg./apt,#: Project name:Coursolle ❑Hazardous locations. ❑Su ply voltage for more than
❑Service or feeder 600 amps or more. 60 volts nominal.
Cross street/directions to job site:
tleseri toy e. Each I Total
New residential single-or multi-family i welling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel
1,000 sq.ft.or less 165.54 4
#:
_ Ea.add'I 300 sq.ft.or portion 33.92 1
:.
Limited energy,residential. • .: ,. r - _.r.. : , .,,, with above .ft. 75.00 2
please add to existing permit ELC2016-00019:Service and 16. new panel,rewire Limited energy,multi-family
residential with above .ft.) 75.00 2
garage,splice circuits due to tire. Renewable EnSW ❑ See a e 2
Services or feeders installation alters,tio and/or relocation
Name:Coursolle 200 amps or less 1 1100.70 1 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZCP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( Over 1.000 amps or volts 552.26 2
Temporary services or feeders installatf n,alteration,and/or
Email. relocation
Owner installation:This installation is being made on prop my that I own which is not 200 amps or less 159.36 1
intended for sale,lease,rent,or exchange,according to OR5 447,449,670,and 701, 201 amps to 400 amps 1125.09 1 F 2
Owner signature: Date: 401 amps to 599 amps 1168.54 2
"""��� µ-• N Branch circuits—new,alteration or ext *ion, er panel
A.Fee for branch circuits with
Business name,Squires Electric,inc. above service or feeder fee, 16 7,42 118.72 2
each branch cin:uit
Contact name: S,Fee for branch circuits without
service or feeder fee,first
Address:657 SE Yamhill St. branch circuit 55.18 2
an
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous service or feeder not incl ded
Phone:(503)252-1609 Fax: :(503) 53-5831 Each manufactured or modular 6784 2
dwelling,service and/or feeder
Email:Andrew�squireselectric.com Recoimect only 67,84 2
Pump or irrigation circle 07,84 2
4—Business name: Sign or outline lighting 67.84 2
Signal circuits)or limited-energy
Address: panel,alteration,or extension. ❑ See age 2 2
V City/Stan/211': Each additional inspection over allowabl in anyof the above
Additional inspection(i hr min) .25/br
Phone:( ) Fax: ) Investigation(I hr min) 1 40.001hr
Email: Industrial plant(1 hr min) I J8.18/hr
Inspections for which no fee is
CCB Lia: 135085 lectrl al ie.: 26- OIC Suprv.Lic.: 4882S s iecall listed ''/:hr min /hr
Suprv.Electrician signature,required Subt at: 219.42
Print name: Joe Squires Date: 2/25/16 ❑Plan Review Required(25%ofpetmit e):
State surcharge(12%of permit ): 2f!33
Authorized signature: TOTAL PERMIT E: 245
This permit application expires if a permit is i of obtained within 180
Print name: Joe Squires Date: 2/25/16 days after it has been auepted a complete.
• Number of inspections allowed per permit.
1:18uildirslFormits\FLC PermilApp ELtt_ERE.doo RevO611712015 ddO.4615T(11/05/C0M/wg$
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
11849 SW 126TH PL, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00019
Jeff Grove
Violation Summary:
Inspector Contractor