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Permit CITY OF TIGARD ELECTRICAL PERMIT II COMMUNITY DEVELOPMENT Permit#: ELC2016-00298 Date Issued: 04/12/2016 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103CA00304 Jurisdiction: Tigard Site address: 11780 SW FONNER ST Project: Spies Subdivision: None Lot: None Project Description: Replace(1)200 amp panel. Contractor: OWNER Owner: SPIES,JOE 11780 SW FONNER ST TIGARD, OR 97223 PHONE: 360-521-6761 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders-200 04/12/2016 $100.70 Specifics: amps or less 1 ea 12%State Surcharge- 04/12/2016 $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 otr- -••' -ble law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuan - - work is suspen.-d for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifi . Center. Those rule are set forth i •AR 952-001-0010 through • 952- 1-0090 You may obtain a copy of the rules or direct questions to OUNC by calli.. 03.232.1987 or 1.800.33 44. Issued By: t 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. Electrical Permit Application FOIz O I1 i c I I SF O\1.1 City of Tigard Received r Permit#: + 13125 SW Hall Blvd.,Tigard,OR 97223 Date/B : 9 /Z /(o *o" 67-6,//- ",(9,A 9, g Plan Review IIIs Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#: Inspection Line: 503.639.4175 Ready Date/By: loris: ® See Page 2 for I I l., \I:I) Internet: www.tigard-or.gov Notified./Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Demolition her: 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. 1-and 2-family dwelling ❑Commercial/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 Fireum p p. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived Job#: Job site address: , I 710 1 ❑Addition of new motor load of system. ,s(A) Fo4',.y T SI00HP or more. ❑"A "E" `1-2' 'l-3" City/State/ZIP: n ❑Six or more residential units. occupancy. 1A' i 0,` ���3 , ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: s''/&—S' 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 Qiy. I Each I Total I New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. -71 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: 01{, 7 3? Ea.add'I 500 sq.ft.or portion 33.92 I DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 2 Ref LI CA.- �4 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) 0 PROPERTY OWNER ❑ TENANT Renewable Energy 0 See Page 2 Services or feeders installation,alteration,and/or relocation Name: Jp,€__ 310r4G J 200 amps or less i 100.70 2 Address: 703'D (SW ran S� 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: T A� , S 72?3 601 amps to 1,000 amps 301.04 / 2 Phone:(3+0 ) - 1g71./ Fax:( ) Over 1,000 amps or volts 552.26 2 I Temporary services or feeders installation,alteration,and/or Email: p rw id-sr , <2, gfMet:1 cane relocation Owner installation:Thi •t . ,tfon is being made on property that I own which is not 200 amps or less 59.36 1 intended fors. , ease,rent,or exch. ge,ac t I'•: - :'-S 447,449,670, nd 701. 201 amps to 400 amps 125.08 2 Owner signature: ;� Date: JZ 401 amps to 599 amps 168.54 2 i FFLICANT ❑ 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 2 - Contact name: B.Fee for branch circuits without service or feeder fee,first 56.18 ' Address: - branch circuit _ City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular 67,84 dwelling,service and/or feeder - Email: Reconnect only 67.84 2 CONTRACTOR 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 Each additional inspection over allowable in any of the above City/State/ZIP: Additional inspection(I hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(I hr min) 90.00/hr Ercall: Industrial plant(I hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lie.: Electrical Lic.: Suprv. Lic.: specifically listed(viz hr min) ELECTRICAL PERMIT FEES Suprv. Electrician signature,required: Subtotal: /a O, 70 Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of pennit fee): /..7 , 0P TOTAL PERMIT FEE: // Authorize 'gnature: a, 7� This permit application expires if a permit is not obtained within 180 Print name: Date:1 f i i64, days after it has been accepted as complete. * Number of inspections allowed per permit. i Building Permits ELC_Pei mitApp ELR ERE.doc Res 06 17 2015 440-4615 B11 05 COM WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FSE sCll . Description I Qty. 1 Each l 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 ❑ G• arage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 ❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ V• acuum 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 I charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(1/2 hr min) COMMERCIAL WORK ONLY: E.ECTRICAL,PERMI'T FEES Subtotal(Enter on Page I): Fee for each commercial system: $75.00 * 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* ❑ M• edical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:t3toldine Permits Fl C PermilApp ELR_ERE.doc Res 06 I-2015 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT II Request for Permit Action TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard, OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ner ❑ Applicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) 'Arg-- 4it Mailing Address: I i--)Fc. 3t,_) FovhA ';S-1 City/State/Zip: / ,Q 5 7 2 2 3 Phone No.: )b- S a(^ 7 ?L. f PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ CANCEL/VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). REMOVE/REPLACE CONTRACTOR ��ON PERMIT (do not cancel permit). 7 ---.1Z Permit #: (_. ri -�/C C - 60)--7 g- Site Address or Parcel #: G 1 ? S6-v P-eivine-7 , Subdivision Name: Lot #: EXPLANATION: ., /i l` . .. Y I ,0.' li Signature: Date: 5/16?//4 Print ame: -----ip, `_ ,-(_ Refund Polic' f" 1. The Community Development Director,Building Official or City I?ngineer may authorize the refund of: • .Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. .All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. Route to Sys Admin: Date * /4, B) Route to Records: Date By Refund Processed: Date By Invoice Processed: Date By Permit Canceled: Date By Parcel Tag Added: Date By l:ABuilding\Forms\Re 1I ermit.Action_1>92314.doc CITY OF TIGARD ELECTRICAL PERMIT .111 s. ' COMMUNITY DEVELOPMENT Permit#: ELC2016-00298 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/12/2016 TIGARD. g Parcel: 2S 103CA00304 Jurisdiction: Tigard Site address: 11780 SW FONNER ST Project: Spies Subdivision: None Lot: None Project Description: Replace(1)200 amp panel.5/3/16,REPRINTED to change contractor to Creative Electric and add(4)branch circuits. Contractor: CREATIVE ELECTRIC INC Owner: SPIES, JOE PO BOX 659 11780 SW FONNER ST WOODBURN, OR 97071 TIGARD, OR 97223 PHONE: 503-634-2454 PHONE: 360-521-6761 FAX: 503-634-5013 FEES Quantity Description Date Amount 1 ea Services or Feeders-200 04/12/2016 $100.70 Specifics: amps or less 4 crt Branch Circuits w/Purchase 05/03/2016 $29.68 Type of Use: SF Service or Feeder Class of Work: ALT 45 Misc Administration Fee 05/03/2016 $45.00 Type of Const: 1 ea 12%State Surcharge- 05/03/2016 $15.65 Electrical Occupancy Grp: Total $191.03 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 a • ••• e 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. , ENTION: Oreg• law re vires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-,•1-0010 through OAR 952-00 9 u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Is-ued By: (.\.. L�--(Au—ate Permittee Signatur§` .. f' 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' ��_ — 7 .,..._1 Date: _4--44r LICENSE NO. S. ' 5 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 1.0R OI 1.1( I i St. 0'\1.1 City of TigarD Received 9© i CP Pennit 8: Date/B III 11 13125 SW Hall Blvd.,Tigard,OR „RECEIVE Plan Review S Phone: 503.718.2439 Fax: 503.598.1960Date/B Related Permit 8: Inspection Line: 503.639.4175 MAY 0 3 2016 Ready Date/By: loris: El See Page 2 for I It, 1LI) Internet: www.tigard-or.gov PLNotified/Method: Supplemental Information TYPE OP WSW y Ot- !IGARO PLAN REVIEW ❑New construction lAddition/altatilliOtagVIS-IO'" 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 CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. /AI-and 2-familydwellingCommercial/industrial less to ground.or exceeds 14,000 0 Commercial-use agricultural ❑ ❑Accessory building amps for all other installations. buildings. ❑ Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived .lob#: Job site address: t 1-- 1 Ito 14,0 014'E ❑Addition of new motor load of system. T r IOOHP or more. ❑"A" "E "l-2" "1-�" City/State/ZIP: ❑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: FEE SCHEDULE Description I Q.Y. I Each I Total 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 Ea.add]500 sq.ftor portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 2 G 0��ev evsj r_ (with above sq.ft.) c—I �-� �Xf'�T����� vimi ted energy,multi-family 75.00 D �X� Tinleh Pa-1,-117Pa-1,-117-64)i {� Rdkraces A residential(with above sq.II.) 75.00 2 � To S Renewable Energy 0 See Page 2 ❑ PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation Name: !.t 4-0-1-4 I 200 amps or less ..g. 100.70 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 I ❑ 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 *4 Z1 7.42 2 Contact name: B.Fee for branch circuits without service or feeder fee,first 56.18 2 Address: branch circuit City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured 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: t eLT2rL E_C ( Sign or outline lighting 67.84 2 � � Signal circuit(s)or limited-energy Address: Q 15-1t / 69 panel,alteration,or extension. 0 See Page 2 2 V l} Each additional inspection over allowable in any of the above City/State/ZiP: zdorjo a "SuQti 0)2._ 9 7C7 Additional inspection(1 hr min) 66.25/hr Phone:(97/) 3r -- g / Fax:( ) Investigation(1 hr min) 90.00/hr t Industrial plant(1 hr min) 78.18/hr Email: cteurN Iv‘.114,44 d; C g>kei.:, 1 e ei,:44 Inspections for which no fee is 90.00/hr CCB Lie.: u&q '76/ ElAl.Electrical Lic.: gc/_ u v. Lic.: 1494)$ specifically listed(%hr min) / ELECTRICAL PERMIT FEES Suprv. Electrician signature,required: X Subtotal: Print name:'–DA N ti ht,}.uzy Date: 5 bo, 0 Plan Review Required(25%of pennit fee): State surcharge(12%of pennit fee): TOTAL PERMIT FEE: Authorized signature: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per pennit. I:Building Permits[1.0_Penn1tApp ELR_ERE.dm: Res 06 17 2015 440-4615T(11 05 COM WFB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENIIAL WWII<ONLY: FEE scl r.;. Description Qt). Each I Total I * 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 with OAR 918-309-0040) 552.26 2 ❑ 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 charged at an hourly(I hr min) Inspections for which no fee is 90.00/hr specifically listed('/:hr min) COMMERCIAL WORK ONLY: E r cn�, PERMIT FEES Subtotal(Enter on Page I): Fee for each commercial system: $75.00 * 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 I Building Permits l'I.C_PermitApp ELR_FRi doe Ret 06 1?2015 L