Permit CITY OF TIGARD ELECTRICAL PERMIT
a COMMUNITY DEVELOPMENT Permit#: ELC2016-00441
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/26/2016
I[afti F8-)f g Parcel: 2S109BA02000
Jurisdiction: Tigard
Site address: 13917 SW LEAH TER
Project: Whipps Subdivision: HILLSHIRE SUMMIT Lot: 5
Project Description: (2)branch circuits for master bath remodel
Contractor: BUCKAROO ELECTRIC Owner: WHIPPS, ROBERT S&CAROLE J
31601 S WRIGHT RD 13917 SW LEAH TER 11
MOLALLA, OR 97038 TIGARD, OR 97224
PHONE: 503-880-6326 PHONE:
FAX: 503-829-5207
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 05/26/2016 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 05/26/2016 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in D. with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ENTION: Orego law -. ires you to follow the rules adopted by the Oregon Utility Notification Ce r. Thos rules are set forth in OAR
952-0 1-0010 through OAR 95 .41-009. ,ou may obtai a copy of the rules or direct questions to OUNC by calling 503. 198 or 1.8 .3 .2344.
Is ed By: \, I pc-- Permittee Signature: ` j.. .
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CO -i'CTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' - 1 Date: 4 4O p
LICENSE NO. 3F5-(/5Y/5 ( Yr`"'
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Applica ' ED FOR OFFICE t £ONE ti
City of Tigard Rec
V >auz.-`iv`d ..5- to a� i Perm"'
'a13125 SW Hall Blvd.,Tigard,OR 972. Plan Review /� ����� �/
'
tY 2 6 2016 ___ -
Phone: 503.718.2439 Fax: 503.59$.t' Uate.sly:)., Related Permit#
Inspection Line: 503.639.4175Ready Oaten;): — orris Q(See Page 2 for
1l',,)?tt) Internet www.tigard-or.gov p�^q
C`�O{(�±T��Af1L/ Notifiedrh3ethod: 1 Supplemental Information
p�
_ TYPE olvisION
PIAN REVIEW
❑New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more (]Building over three stories.
❑Demolition Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRti(i1ON exceeds 10,000 amps at 150 volts or Cl Floating buildings.
1-and 2-family dwelling ❑Commcrciallindustrial ❑Accessory building
g...
Multi-family 0 Master builder 1:1 Other: lees to ground,or exceeds 14,000 p Commercial-use a iealtarat
cps for all ocher installations.Fire pump,
buildings.
. El Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
0 Addition of new motor toad of system.
Job#: l Job site address: )32i-7 $ Lick /_,-I- 100HP or more.
❑Six or more residential writs. occupancy.Ci State/IiP: �)C+sAA6a( q-/ 74 If
-- _, ❑Iteaktr-care facilities. [i Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 4, $� &04 ct - ❑Hazardous locations. ❑Supply voltage kw more than
'vim, _ .-"`" -- ❑Service or feeder 600 amps or more. 6W volts nominal.
Cross street/directions to job site:
FEE SCHEDIJt.F,
-- iieseriptiea----- Qty. i--- —aehTotal T•--
____-_....._...__.. Ncw residential single-or multi-family dwelling unit.
Subdivision: �_— 1 Lot#: includes attached garage.
1,000 sq,it or less 168.54 4
Tax map/parcel#: -----
_ Ea__ _ Ea add'l 500 sq.ft or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential --
% (with above set 8.)
_-.__ Limited energy,multi-family 75.00 2
residential(with above sq.ft.) 75.00
PROPh RTY OWNER d TEN T Renewable E - 0 See Page 2 y
Services or feeders installation,alteration,and/or relocation
Name: 130(3-I,b)PC.E,I.Ji-JI PPL_ 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
-
Email: -�___ ._..-__ -._ Temporary services or feeders installation.alteration,and/or
relocation
Owner installation:This installation is being made on property that 1 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
(honer signature: -_._.-- - -- --,---_-- -_ Date: 401 amps to 599 amps 168.54
-'-_ Branch circuits-new,alteration,or extension,der panel
X1 APPLICANT r - COl�I'ACt PERSON
j�
^^ _ t/"1. -�--------_. __---__. A.Fee for branch circuits with
Business name: C C..O.iSliZV W /_ Q above service or feeder fee. 2
C.'�I _.___.. N ----StCJ.L_ S� ._., each branch circuit 742
Contact name: . B.Fee for branch circuits without
Address: v_. service or feeder fez first
9s- N W GOO 4 branch circuit 56.18 5 2
Each add't branch circuit 7.42 2
City/State/ZIP: � ,[ on/ 0 97666 I
( � y 9 31� Miscellaneous{service or feeder not included)
Phone: ) 5 Fax::( ) Each manufactured or modular
�� 67.84 y
dwelling,service and/or feeder
Email: T(IQ C.0i...e. 1"*Y,04 1-ILUCI-joi R Ctsh/‘.-
___ - Reconnect only 67.84 2
��7,Jfs� CONTRACTOR fs % Pump or irrigation circle 67.84 2
Business name: t rTe,( .,t� i�� YV Si or outline lighting 67.84 �y 2_
Address: 1 �/� J�,.J Signal circuit(s)or limited-cner�; fl See Page 2 2
` (>,e�f g` �+ E`-"'+ panel,alteration,or extension.
City/State/ZIP: -6 3 zjA '( Each additional inspection over allowable in any of the above
'i� � - -._.__..___ __ � 8_ Additional inspection(i hr min) 66.25/hr
Phone:(63)2, -c� ,f Fax:( ) Investigatron(1 hr min) 90.00/ktr
e �' Industrial plant(1 whrhich
min) 78.18/hr
backer 'a,.+' Tc.., fa'/ ' lnspectiotrs for which no fee is
CCB Lic.:�s tl/7.5-0 Electrical Lie.: l3 fC TSuprv.I.ic 39.5 S
specifically listed CA hr mitt) 90.011/hr
ELECTRICAL PERntrr FEES
Suprv.Electrician signairlre,required: ______�__._----_-__--_.__._____.
Gr+,GQ47 Subtotal: tp 4,,0
Print name: ArliKgAi fr'ee f if//._ Date:5-2.5-f ❑Plan Review Required(25%ofpemet fee):
State surcharge((2%of permit fee): 43
Authorized signa ure:
TOTAL PERMIT FEF.: 7] 2..:`
This permit application expires if a permit is not obtained within 180
rPrint name: l Date: days after it has been accepted as complete.
__.. + Number of inspections allowed per permit.
I\&nldittePeraue.uELC PennitApp FIR,F.R.F.doe Rev 06 117:2015 4404015Th!4.'05/COM/WElt
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
13917 SW LEAH TER, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00441
Jeff Grove
Violation Summary:
Inspector Contractor