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Permit (43) CITY OF TIGARD ELECTRICAL PERMIT 11. 11 ' ' • COMMUNITY DEVELOPMENT Permit#: ELC2016-00259 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/31/2016 Parcel: 2S111BA06800 Jurisdiction: Tigard Site address: 9541 SW INEZ ST Project: Ban Subdivision: BUTLER TERRACE Lot: 2 Project Description: (7)branch circuits for Converting existing garage into habitable space for foster care. Contractor: SPEKTRUM ELECTRIC INC Owner: BAN, MIRCEA&DIANA 13215 SE MILL PLAIN BLVD 9541 SW INEZ ST VANCOUVER,WA 98684 TIGARD, OR 97224 PHONE: 425-919-2705 971-300-2351 FAX: FEES Quantity Description Date Amount 7 crt Branch Circuits wo/Purchase 03/31/2016 $100.70 Specifics: Service or Feeder 1 ea 12%State Surcharge- 03/31/2016 $12.08 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 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 --•icable 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 .ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cen— Those s are set forth in Or 952-001-0010 through 0 952-001-0090. You reayvbteii py of the rules direct questions to OUNC by calling 5r• 19 or 1.800.3 44. i Issued By: PPmritteeSignature: _ 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 ,, [oR[OR01 I•l( I t 51.. U y I.1 City of Tigard DRale/Bed: �f'4 jrirArin. i :11 IN 13125 SW Hall Blvd.,Tigard,OR 97 i Plan Review ■ Phone: 503.718.2439 Fax: 503.5 v f tom✓' Date/B : Related Permit#: Myr, O 1.571 , _: Inspection Line: 503.639.4175 YY 1 1Q�� Ready Date/By: ® See Page 2 for I I t 1 R 1 Internet: www.tigard-or.gov ``►�, 3 1 1 t �� Notified/Method: _ Supplemental Information . TYPE OF WORts C A v..— .A,... PLAN REVI&w , ❑New construction ❑Addition/alteration ,1 y Please check all that apply(submit 2 sets of plans w/items checked): ID Demolition ❑Other: 4 0 Service or feeder 400 amps or more 0 Building over three stories. ♦ where the available fault current 0 Marinas and boatyards. CATEGORY OF CONST:10, exceeds 10.000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14.000 0 Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: I Job site address: SIS''/ .S W /k.2. S.7-. 100HP or more. ❑"A","E "l-2","l-3", r� 0 Six or more residential units. occupancy. City/State/ZIP: 7 CA-R-6I Q f�+ �� 2�j 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: FEE SCHEDULE Description I Qty. _ 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 75.00 2 (with above sq.ft.) QUI(✓(/113 6) �—�f /13 Limited energy,multi-family J 75.00 2 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 2 201 amps to 400 amps 133.56 2 Address: 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 0 CO ACT PERSON Branch circuits—new,alteration,or extension,per panel �� /eUøi �/ A.Fee for branch circuits fee,Business name: {gyre' `�nni(fl above service or feeder fee, th 7.42 2 each branch circuit Contact name: 9//d -7i b� i 0/(04/1.-r CZ_ B.Fee for branch circuits without Address: /t , L r iAm) 5)1 I b service or feeder fee,first 1 56.18 �r'' f2 2 �� (� (S ., branch circuit J(� b City/State/ZIP: V(�^�c�A/v4 �,4 7 7 4 Each add'I branch circuit 6 7.42 Ltt sa 2 MPhone:(,5-15).5 5172_ OC-b 9ci�1�Fax: : ! Each manufacturedlaneouu or(serviceoru feeder not included) ( ) Each or modular 67.84 2 dwelling,service and/or feeder Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: ieg 7- ce 51e /81 e_ Sign or outline lighting 67.84 2 P^ £ Signal circuit(s)or limited-energy 0 See Page 2 Address: r 3/ J SCS �', `/ /'4 j) ,///D panel,alteration,or extension. g 2 City/State/ZIP: L a��1A' e...`tQ` �4 `?E? /�Ell/ Each additional inspection over allowable in any of the above (7 vL�! Additional inspection(1 hr min) 66.25/hr Phone:( 10)3 5r4 .j 4, gig) Fax:( ) Investigation(1 hr min) 90.00/hr Email: 7A/17 ,/ /f Industrial plant(1 hr min) 78.I8/hr f Inspections for which no fee is CCB Lic.:020 9 6 r Electrical Lie.: C / V r uprv. Lie.: 4'?I specifically listed('V hr min) 90.00/hr ., ELECTRICAL PERMIT FEES Suprv. Electriciani',required: f Subtotal: Print n fVe)($/U©e— a�j'tM/lea, Date: /7 i a/ ` l6 0 Plan Review Required(25%of pennit fee): 11/r/ [/r ti State surcharge(12%of permit fee): fAi,OK Authorized signature: TOTAL PERMIT FEE: Q This permit application expires if a permit is not obtained within MO Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I:Building Permits,ELC PermitApp ELR_ERE.dor Res 06972015 440-4615T(II 05 COM WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: , �' •J 't � ..k�. i'"��.�.zz OY, f ,6' '"k T, �' , ;; a 1 Description Qty. Each [ Total Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) ❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* y Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva-no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed('/s hr min) COMMERCIAL WORK ONLY: iEt;EicrhicAaiT iri,s Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): y * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations L Building Permits Iit C PernioApp ELR_ER!.doc Res 06 17 2015