Permit (41) :11111
CITY OF TIGARD ELECTRICAL PERMIT
'' COMMUNITY DEVELOPMENT Permit#: ELC2016-00263
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/04/2016
Parcel: 25111 BC00500
Jurisdiction: Tigard
Site address: 10055 SW INEZ ST
Project: GRADIN Subdivision: TIGARDVILLE HEIGHTS Lot: 19
Project Description: (3)branch circuits for washer,dryer,and ceiling fan.
Contractor: OWNER Owner: GRADIN, DANIEL L&SALLY K
DANIEL GRADIN 10055 SW INEZ ST
10055 SW INEZ ST TIGARD, OR 97223
TIGARD, OR 97224
PHONE: 360-200-2707 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 04/04/2016 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 04/04/2016 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 C er. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You nhtain a co o r les or direct questions to OUNC by calling 503.23 . 98 or 1 80 2.2344.
Issued By: Permittee Signature: C
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 u o R()111( 1 I SE ON 1.1
Cityof 1 I and Al'4
Received / Permit#. _
g Date/B : hp L r a
III 13125 SW Hall Blvd.,Tigard,OR 97223 � Plan Review
•
Phone: 503.718.2439 Fax: 503.59 tl ,)? Date/By: Related Permit#: /O,Oi�-.
Inspection Line: 503.639.4175 C Ready Date/By: fur i int See Page 2 for
I It, \I:I) Internet: www.tigard-or.gov O�U Notified/Method: Supplemental Information
1"11CIVA
TYPE OF WOIi -(�...1 PLAN REVIEW ,
0 New construction Addition/alteratto /reel ' V Please check all that apply(submit 2 sets of plans w/items checked):
` � 0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONS - II 0'I,; exceeds 10,000 amps at 150 volts or 0 Floating buildings.
�` Accessorybuildingless to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 1-and 2-family dwelling ❑Commercial/int t 0 amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: ['Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address:/005-c— Sc " 0 Addition of new motor load of system.
. IOOHP or more. ❑••A" "E "1 2" "1-i"
City/State/ZIP: //'' ❑Six or more residential units. occupancy.
Y �!K � Q ��2� ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: /4 Aederil 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 Qlv. 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.addl 500 sqftor portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
Tii /l i / C/ l 4J ///R r[.._ "-- �/ (with above sq.ft.) 75.00 2
GSI' ✓ z l �(/ J/1�%j Limited energy,multi-family 75.00 2
P1t4,
( ru♦ �:4 At/ liOvi residential(with above sq.B.)
`, �/PYROP TY OWWN/ER/� Renewable Energy ❑ See Page 2
(� 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: L94-.i/ 624.4/4/ 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address: /19O5 (,� e� S�
-7 401 amps to 600 amps 200.34 2
City/State/ZIP: 7-/61-74 4,Q q -LZ 601 amps to 1,000 amps 301.04 2
Phone:(360 Zoo - 27e3— 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, to 599
leas, t,or exc i;ccording to ORS 447,449,670, nd 701, 201 amps to 400 amps 125.08 2
s20 APPLICANT ❑ CONTACT PERSON
Owner signature ' Date:._ ,6 401 amps amps 168.54
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 2
Contact name: B.Fee for branch circuits without i
service or feeder fee,first
56.18 2
Address: branch circuit J
City/State/ZIP: Each add'I branch circuit Z 7.42 jy n i 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: d W /V Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(I hr min) 78.18/hr
Email:
Inspections for which no fee is 90.00/hr
CCB Lie.: Electrical Lie.: Suprv. Lie.: specifically listed('/z hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal: 7/ d
Print name: Date: 0 Plan Review Required(25%of permit fee): -,--
State surcharge(12%of permit fee): In
Authorized signature TOTAL PERMIT FEE:
-7,?,5',/
/� -7/2./h� This permit applicationysrhexpires if na permit isnoto tale. within 180
Print name: 0•14/[( Date: days after it has been accepted as complete.
* Number of inspections allowed per pennit.
L Building Permits ELC_PermitApp ELR_ERE.dee ReN 06 17 2015 440-4615T(11 05 COM WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
Description Qt}. 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* 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
specifically listed('h hr min) 90.00/hr
COMMERCIAL WORK ONLY. EIiktitl[CAL PERMIT FEES
Fee for each commercial system: $75.00 allowed
Subtotal(Enter on Page 1):
y * Number of inspections alloweper 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
I Buildintt Permits EL C PennitApp ELR_ERkl.doe Rec 05 17 2015