Permit CITY OF TIGARD ELECTRICAL PERMIT
11111 I' COMMUNITY DEVELOPMENT Permit#: ELC2016-00157
T FGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/02/2016
Parcel: 2S110DD01100
Jurisdiction: Tigard
Site address: 15940 SW GREENS WAY
Project: Christensen Subdivision: SUMMERFIELD Lot: 89
Project Description: Furnace installation.
Contractor: ENGELMAN ELECTRIC INC Owner: CHRISTENSEN, BRIAN&DIANE MARIE
PO BOX 451 TRUST
HUBBARD, OR 97032 1090 NORTHVIEW DR
BEAUMONT, CA 92223
PHONE: 503-981-8041 PHONE:
FAX: 503-981-4026
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 03/02/2016 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/02/2016 $6.74
Type of Use: SF Electrical
Class of Work: ALT 1 ea Investigation Fee 03/02/2016 $90.00
1 ea Investigation 12%State 03/02/2016 $10.80
Type of Const: Surcharge
Occupancy Grp:
Total $163.72
Required Items and Reports(Conditions)
This pen-nit 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 952-001-0090. You may o o s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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.
Mer/01/2016 11:41:37 AM en Electric - 503-981-4026 1/2
Electrical Permit A r 'lie's► t o I/, i 'of; t it s is 1. I sl.(I\i )
City of Tigard rg ;_. .: 3 / /o, 4j - Permitri: 1 1G-001 S'
111111 - q I3125 SW Hall Blvd,,Tiger. OR 9 . . . view �/
• 1 Phone: 503.718.2439 Pax: -, 598.1960 att/By: Related Penh 0:M�.Ar)((O-fy)( 3
r I r.r Inspection Line: 503.639.4175 Ready Dato/By� MHz see loge 2 for
Internet: www.tigard-or.gov Notified/Method: 0 Supplemental Information
7YPZ:Q WORK 2 .
0 New construction ®Addition/alteration/replacement Please cheek ell that apply(submit 1,sets of plats w/kern-checked):
0 Demolition ❑Other: CI Service or feeder 400 amps or more 1:]Building over three stories,
where the available fault current in Marinas end boatyards.
C.'ATEGORY,:UP:CONSTRUCTION accede 10,000 amps.1150 volts or ❑Ploenng buildings,
®1-and 2-family dwelling 0 Commercial/industrial E Accessory building leas to ground,or exceeds 14.000 ❑Commercial-use agricultural
amps for all other installations, buildings.
0 Multi-family 0 Master builder 0 Other: ❑Fire pump. 0Instillation of 150 KVA or
MB-WE INFORMATION AND.LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#:30613 Job site address:15940 SW Greens Way 100HP or more. ❑"A","B","1•2""1.3"
City/State/ZIP:Tigard OR 97224 ❑Six or more residential unite. ncy.
❑Health.cara thalities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name eIfer+s/Christensen 0 Hazardous location.. 0 Supply voltage for more than
- 0 Service or Rieder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FFA SCRIKTIE
Detcrlpdsa J qg. I item I Tom I •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
-Tax map/parcel#: 1,000 sq.ft or less 168.54 4
En add'I 500 sq.ft.or portion 33.92 1
ABl9 PTIONiOP:W.QRK. .. Limited energy,residential
gas furnace circuit (with above aq.It) •
75.00 2
Limited energy,multi-family 75,00 2
residential(with above ee.ft,) .
Renewable Energy 0 See Page 2
0 PROPERTY.(AVM Q.TENS ,Services or feeders lnstallation,alteration,and/or relocation_
Name: 200 amps or less 100.70 2
—
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/Z)P: 601 amps to 1,000 amps 301.04 2
Phone:( ) I Fax;( ) Over 1,000 amps or volts 552,26 2
I 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 l
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
Branch circuits-new,alteratio_ty or extension,per panel
41411116 ' T 0 A.Poe for branch circuits with
Business name:Engelman Electric Inc above service or feeder fee, 7.42 2
each branch circuit
Contact name:Kristina Nichols B.Fee for branch circuits without
service or feeder fbe,first 1 56,18 56.18 2
• Address:P O Box 451 branch circuit
Each add'/branch circuit 7.42 2
City/State/ZIP: •
Hubbard OR 97032
Miscellaneous(service or feeder not included)
Phone:(503)981-8041 Fax::(503-)981-4026 Each menutbctured or modular _
67.84 2
Email:kris( engelmanelectric.com dwelling,service atld/ortbeder
Reconnect only 67,84 2
Ci71VTRACTOR Pump or irrigation circle -
67.84 2
i' Business name:Engelman Electric Inc Sign or outline lighting 67.84 2
dress:P 013olt 451 Signal t(s)or limited-energy_ 0 Ste Page 2 2
panel,alteration,or limited-energy
1t---4C-ACiy/State/ZIP:Hubbard OR 97032
Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
1 Phone:(503)981-8041 Fax:(503)981-4026 investigation(I hr min) 90.00/hr
Email:kris@engelmanelectric.com Industrial plans(1 hr min) 78,18/hr
J �� Inspections fbr which no fbe is 94,00/hr
CCB Lic.: 94581 Electrical : 24-46c Suprv.Lie.: 739S specifically listed(15 hr mm)
ELECTRICAL.REllM T MS
Suprv.Electrician signature,required: Subtotal: 56.18
Print name: Ron Thunderbird Date: 03/01/16 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 6.75
Authorized signature: TOTAL PERMIT FEE: - : (�.qol
This permit application aspire'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.
1:1BuIldlnsTermIut6LCfemdtApp,JLR,) ,deo Rev 06/17/2017 4,10-4017711(05/C074/WEBj
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