Permit CITY OF TIGARDIN ELECTRICAL PERMIT
■ COMMUNITY DEVELOPMENT Permit#: ELC2016 00004
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/07/2016
TIGARD Parcel: 2S109DA03100
Jurisdiction: Tigard
Site address: 15327 SW GREENFIELD DR
Project: Bank of New York Subdivision: SUMMIT RIDGE Lot: 8
Project Description: Reconnect only.
Contractor: OWNER Owner: BANK OF NEW YORK/MELLON
8742 LUCENT BLVD, STE 300
HIGHLANDS RANCH, CO 80129
PHONE: 303-895-2662
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 01/07/2016 $67.84
Specifics:
1 ea 12%State Surcharge- 01/07/2016 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through 0 9 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: --- Permittee Signature: e� (7/)".4/('AI-770/k/
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Date/B1'4% ed / 7 �!o Permit#:E - � ,/Qv
13125 SW Hall Blvd.,Tigard,OR 97223 ) Plan Review
Phone: 503.718.2439 Fax: 503.598.196 Date/B : Related Permit#:
M
' Y• Inspection Line: 503.639.4175 16 Ready Date/By: Ruts: ® See Page 2 for
�+.:444'F� Internet: www.tigard-or.gov . Notified/Method: Supplemental Information
t1, ., t .'',i l 'rrOg,.. . :'
❑New construction ❑Addition/alteration/replac �`
Please check all that apply(submit 2 sets of plans w/items checked):
t� �����, 0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ®Other where the available fault current
❑Mannas and boatyards.
mgmt � � 6 a 's$ .,,'...Zi';:',. ;'-i':;:-.,:- .,'-':: - 10,000 amps at 150 volts or
Floating buildings.
El 1-and 2-family dwelling EICommercial/industrial ■ Accessory building
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
=.larlifil:' 701IWErfaaTIND b tZe a .y:s ' -:`, 0Emer6enc system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 15327 SW Greenfield Dr I00HP or more. ❑"A","E","1-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: 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:Beef Bend Dr to Greenfield Dr VIIPMMjnattrgtantlgaRf
Description I Qty. I Each I Total *
New residential single-or multi-family dwelling unit.
Subdivision:Summit Ridge Lot#:8 Includes attached garage.
Tax map/parcel# R2132377 1,000 sq.R.or less 168.54 4
' . a,a
t* Ea.add'1 500 sq.ft.or portion 33.92 1
lit . iglil,4 .y, CR
DESIPTION OI y 0* ylailf _- l Limited energy,residential 75.00 2
Electric Inspection to reconnect electricity (with above sq.ft.) .
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
I:illiNlit t arc d Renewable Energy ❑ See Page 2
❑,IIPROPERTY OWNER a'W ,7 , ,; .Q TENANT. .,, Services or feeders installation,alteration,and/or relocation
Name: Bank of New York/Mellon 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address: 8742 I ucent Rlvd Suite 300 401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps2
Highlands Ranch n R01�9 301.04
Phone:( 303) 895-2662 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 I
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
411"" 1 -t®°APPLICANT, , f}7) A * l '® COj`Ii'.q.C'0 PER.SQN M . Branch circuits—new,alteration,or extension, er panel
"'� A.Fee for branch circuits:t
Business name: Kelly Right Real Estate above service or feeder fee,
each branch circuit 7'42 2
Contact name: Kathy Graham B.Fee for branch circuits without
service or feeder fee,first
Address:4299 NW Tamoshanter Way branch circuit 56.18
City/State/ZIP: Portland,OR 97229 Each add'!branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone: (503)8911-1729 Fax: :( ) Each manufactured or modular
67.84 2
dwelling,service and,/or feeder
Email: kgrahamproperties@comcastnet Reconnect only 1 67.84 67.84 2
9 ! : +11Nt i 'ria 1 CQNTRACTOR ,r, =j ,*rye ?' „;y w 5 it Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. 0 See Page 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(I 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.: s ecdlcaq listed(Vi hr mm)
1l * " �0:f_RITA1 'TRM3' ! ,
Suprv.Electrician signature,required: Subtotal: 67.84
Print name: I Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 8.14 17...„...--
Authorized signature: K d 1 ie-M, TOTAL PERMIT FEE: 75.98
This permit application expires if a permit is not obtained within 180
Print name: Kathy Graha ' 4..°7".7O Date: 01/06/2016 days after it has been accepted as complete.
Number of inspections allowed per permit. I
I:`BuildingAPcrmits\El_C I'ermitApp_ELR_ERE.doc v06/1 015 440-46157111,05/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
15327 SW GREENFIELD DR, TIGARD, OR,
97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00004
Chip Barnett
Violation Summary:
Inspector Contractor