Permit „ CITY OF TIGARD ELECTRICAL PERMIT
I • COMMUNITY DEVELOPMENT Permit#: ELC2016 00137
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/24/2016
Parcel: 2S114BA02800
Jurisdiction: Tigard
Site address: 9680 SW SERENA WAY
Project: Porter Subdivision: PICK'S LANDING NO.2 Lot: 111
Project Description: Kitchen and garage remodel,replace panel and(10)branch circuits.
Contractor: SAFE ELECTRIC INC Owner: PORTER,TERRY L&CAROLYN J
PO BOX 1677 9680 SW SERENA WAY
GRESHAM, OR 97030 TIGARD, OR 97224
PHONE: 503-998-8832 PHONE: 503-481-0979
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 02/24/2016 $100.70
Specifics: amps or less
10 crt Branch Circuits w/Purchase 02/24/2016 $74.20
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 02/24/2016 $20.99
Electrical
Type of Const:
Occupancy Grp:
Total $195.89
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 don ' —a-ccordance 'th 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
da . ATTENTION: Oregon I- =•uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
2-001-0010 through OAR• -001-0;• You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19870344.
Issued By: it �/��� _� 1 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' x �. Date: aQy4
LICENSE NO. 4/3 4
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 Applica Ej rt Ftllz tlrrici.. I su. ()yI l
City Of Tigard - Received Permit#: / /,(
Date/B : 'I� J �/ ee--�l J7
IIII 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503. 6 C Related Permit#:
�� � 4 2(�,r) Date/B
Inspection Line: 503.639.4175 Ready Date/By: funs: ® See Page 2 for
I Ii.,A 1 Internet: www.tigard-or.gov , , , Notified/Method: Supplemental Information
Tv', a {+ vAl PLAN REVIEW
❑New construction Addi 4.1/. l 1 dfILV0t 1dIYP Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other: 0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
dwelling El ❑Accessory building
❑ 1-and 2-familyless to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
9 lw s r�4 , ❑Addition moew motor load of system.
Job#: Job site address: C.1 '/ /- /Z,< <J`(/T'7t tooHP or more. ❑"A","E","1-z",°'t-3",
City/State/ZIP: +�-1 A 4-it. C1Tt. , ? �'� `� 0 Six or more residential units. occupancy.
4 ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Wp a_T-cam 0 Hazardous locations. 0 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: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'i 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
t-/r i1 F_,/ f- �„,�)/1 A/i /z1Y/O 6 i, L (with above sq.ft.) 75.00 2
n "�`l Limited energy,multi-family 75.00 2
s /'L 1-c—j Lb L7,-2/ c4-4._ ,,1 residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less ' 100.70 /O.7) 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:( ) 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
0
APPLICANT ID CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7'42 t7 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Phone: Miscellaneous(service or feeder not included)
( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
sCONTRACTOR Pump or irrigation circle 67.84 2
Business name: 5 4 ,L
- - I Lf L/"/Z-/L //f c , Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: p, c) .1 V / ro -'l- panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: CAA A-F S H -1 v 4 _ , . -03 0 _ Each additional inspection over allowable in any of the above
/ Additional inspection(1 hr min) 66.25/hr
Phone:(5 09 "9 g.—ic3 2_ Fax:( ) investigation(1 hr min) 90.00/hr
�'s Email: J l�1t t Y Industrial plant(1 hr min) 78.18/hr
/ Inspections for which no fee is 90.00/hr
CCB Lic.: j C. t5 6 Electrical Lic.: G 25 9 1 Suprv. Lic.:4-3 c4-s specifically listed(%=hr min)
ELECTRICAL PERMIT FEES ,,
Suprv. Electrician signature,required: Subtotal: /7Y. 9V V
Print name: 41) /1-1)( /;v 0(Lv/tat Date: y-- Z 4_ - l k 0 Plan Review Required(25%of permit fee): '--'
I State surcharge(12%of pennit fee): 020,9?
Authorized signature: TOTAL PERMIT FEE: /95,g-T
f This permit application expires if a permit is not obtained within 180
Print name: It;1-3/
m77/ U i U nv/- Date: ' — _ / days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:Building,PeimitsELC_PermitApp_ELR_ERE.doc Rev 06172015 440-4615T(I 1/05/COM'WEB
Location:
Record Type:
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Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9680 SW SERENA WAY, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00137
Herb Stabenow
Violation Summary:
Inspector Contractor