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Permit (31) CITY OF TIGARD ELECTRICAL PERMIT ' COMMUNITY DEVELOPMENT Permit#: ELC2016-00347 13125 SW Hall Blvd.,Ti Date Issued: 04/27/2016 Trc,�l�.p and OR 97223 503.718.2439 9 Parcel:a c 2S111DB08400 Jurisdiction: Tigard Site address: 15370 SW OAKTREE LN Project: Fireplace insert Subdivision: SUMMERFIELD NO.10 Lot: 545 Project Description: (3)branch circuits for furnace,A/C and service outlet. Contractor: THREE DOG ELECTRIC Owner: HILL FAMILY TRUST 5250 SW CAMERON RD. BY MARION HILL TR PORTLAND, OR 97221 15370 SW OAKTREE LN PORTLAND, OR 97223 PHONE: 503-246-4726 PHONE: FAX: 503-246-2113 FEES Quantity Description Date Amount 3 crt Branch Circuits wo/Purchase 04/27/2016 $71.02 Specifics: Service or Feeder 1 ea 12%State Surcharge- 04/27/2016 $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 Center. Tho - rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a c ules or direct questions to OUNC by calling 50 . 2.19; o 1.8'x.332.234 Issued By: /% ermittee 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 �, , ; FOR t)IFI( I I SI t)\1.1 City of Tigard is r Received �� 13125 SW Hall Blvd.,Tigard,OR 972 Date/B : 0. _ - i - -r 4 g Plan Review 1 Phone: 503.718.2439 Fax: 503.598.1960 ry 016 Date/B : • Related Permit#: �� ` Inspection Line: 503.639.4175 APR i / Ready Date/By: RI See Page 2 for I (..\RI) Internet: www.tigard-or.gov .I Notified/Method: R� III Supplemental Information TYPE OF WOI % 0k utt�=� �n ���1��`1 PLAN REVIEW ❑New construction ddition/altera >I }Can N Please check all that apply(submit 2 sets of plans w/items checked): Dv_ 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. Ri-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground.or exceeds 14,000 0 Commercial-use agricultural 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 � 0 Addition of new motor load of system. Job#: Job site address:637 0 s � O Ai.1_� LN 100HP or more. ❑"A "E "1-2'."i-1', City/State/ZIP:—C`` ^^� �j 0 Six or more residential units. occupancy. b 1��-o 1 —\�ZZi 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 Qiy. I Each I Tota l 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 p / (with above sq.ft.) ER,CON q•�.0 CCArS t-(,JLiJi'�.�t.., IV i-----_-.61-) e tQ'au IT Limited energy,multi-family - 75.00 2 FO 2 IAC V N l fANO S Pik. i cic. OUTL re residential(with ybove sq.ft.) r+� T Renewable Energy 0 See Page 2 0 PROPERTY OWNER u TENANT Services or feeders installation,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/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 APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name:—�/�p a, E. above service or feeder fee, ( fTl� it �0 E.Ll TQ.1�� each branch circuit 7.42 2 Contact name: B.Fee for branch circuits without service or feeder fee,first I 56.18 o Address: branch circuit ` City/State/ZIP: Each add]branch circuit Z 7.42 /y,211 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 - Business name:�� RE zcPump or irrigation circle 67.84 2 Sign or outline lighting2 C_ Dob vi:._ L3 ctiu Si 6 67.84 /� Signal circuit(s)or limited-energy ❑ See Page 2 2 Address: S 2 S 6 S, (.0 . (/n ALA I—_Q.sn w (10 panel,alteration,or extension. City/State/ZIP: r� �(-7 Each additional inspection over allowable in any of the above UQ � T LYo , Q ` t 2-2_1 Additional inspection(1 hr min) 66.25/hr Phone:(60 3 2y b _ 1-172-Co Fax:(So 3 )Z4 to _zits Investigation(1 hr min) 90.00/hr Email: Industrial plant(I hr min) 78.18/hr • Inspections for which no tee is 90.00/hr CCB Lie.:i'3 b5ock Electrical Lie.:C i 9)9Suprv. Lie.: 4c, i 3 s specifically listed(/z hr min) ELECTRICAL PERMIT FEES Suprv. Electrician signature,required: f` \L Subtotal: —7/- Oa Print name: F el L C a tQ Date: 4_-?..7...--201f, ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): i 5}, Authorized signature: TOTAL PERMIT FE . ,�74 4 This permit application expires if a permit is no Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. 1.Building Permits ELC PermitAppELR ERE doe Rex 06 17 2015 440-46151(11 05 COM WEB Electrical Permit Application-City of Tigard Page 2-Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: ';itESIDENIIAL ,n, :' PEE Sc rI,*.E; Description I I Qts Each —1,.....�.Total Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: s 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 I charged at an hourly(I hr min) Inspections for which no fee is 90.00/hr specifically listed('/z hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES. Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): * (SEE OAR 918-309-0000) Number of inspections allowed per permit. 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 Fl C PermitApp t-LR ERE.doc Rev 05 17 2015 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 15370 SW OAKTREE LN, TIGARD, OR, 97224 Residential - Electrical 199 Electrical final PASS - No C of O ELC2016-00347 Jeff Grove Violation Summary: Inspector Contractor