Permit 14, CITY OF TIGARD ELECTRICAL PERMIT
111 COMMUNITY DEVELOPMENT Permit#: ELC2016-00486
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/13/2016
T[t A R.�� 9 Parcel: 2S 111 CA00101
Jurisdiction: Tigard
Site address: 9490 SW SATTLER ST
Project: Ghaffari Subdivision: ALDERBROOK FARM Lot: 13
Project Description: New 100 amp service
Contractor: SOLEDAD ELECTRIC INC Owner: GHAFFARI,ABDUL RAHIM
1518 NE BUFFALO ST 9490 SW SATTLER ST
PORTLAND, OR 97211 PORTLAND, OR 97224
PHONE: 503-756-2220 PHONE:
FAX: 971-271-8465
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 06/13/2016 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 06/13/2016 $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 applicable law. All work will
be done •• accordance . h 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. • TENTION: Oregon - , eq,ire you to follow the rules adopted by the Oregon Utility Notification Center. Jose rules are set forth in OAR
952-061-0010 through OAR 9 I 1-0091. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1*; or ,:60.332.2344.
I �
Iss ed By: 4 1 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' A `/ Date:
LICENSE NO. / 4PIO s5
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.
iaL,Electrical Permit Applic „,,,4„„V .J FOR OFFICE LSE ONE l
City of Tigard q n Received i `/O ,� Pennit#: ELC�D/(o—�c/8 ,
13125 SW Hall Blvd.,Tigard,OR Jtf�' 1 3 ?016 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175c p%j� £ 1 1,11„.'S+D f) Ready Date/By: tuns: gi See Page 2 for
Internet: www.tigard-or.govpp -T,i1 1��ii�, 1�1i A Notified/Method: Supplemental Information
TYYB aD ba046 DIVISION PLAN REVIEW
0 New construction ,Addition/alteration/replacement 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.
El 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.
0 1-and 2-family dwelling ❑Commercial/industrial ❑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
Job#: Job site address: �/ /� L ,.❑Addition of new motor load of system.
8 3 7 I 9.y ! 0 S Ct. 51) 7, 1? 100HP or more. ❑..A,, ..E,, ..1 2,> ..1 3„
City/State/ZIP: ?7?---2-1/ 0 Six or more residential units. occupancy.
❑Healthcare facilities.
0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: 0,./..,4,-F--„,., ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
DESCRIPTION OF WORK Ea.add'l 500 sq.ft or portion 33.92 1
�L
�� r
N” l.' ��\ �� LY' l L _ Limited energy,residential 75.00 2
f (with above sq.ft.)
1 Limited energy,multi-family 75.00 2
0 PROPERTY OWNER I ❑ TENANT residential(with above sq.ft.)
Name: Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Address:
200 amps or less
/ 100.70 /0O 70 2
City/State/ZIP:
201 amps to 400 amps 133.56 2
Phone:( ) I Fax:( )
Email: 401 amps to 600 amps 200.34 2
Owner installation: This installation is being made on property that I own which is not 601 amps to 1,000 amps 301.04 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701.
Over 1,000 amps or volts 552.26 2
Owner signature: Date:
0 APPLICANT I ❑ CONTACT PERSON Temporary services or feeders installation,alteration,and/or
relocation
Business name: 200 amps or less 59.36 1
Contact name: 201 amps to 400 amps 125.08 2
Address:
401 amps to 599 amps 168.54 2
City/State/ZIP:
Branch circuits—new,alteration,or extension,per panel
Phone:( ) I Fax: :( ) A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Email: each branch circuit
B.Fee for branch circuits without
{ x 56.18 2
CONTRACTOR service or feeder fee,first
Business name: -C- It'4110
1 1! Af L ( branch circuit
Each add1 branch
h circuit 7.42 2
Address: ' L1 h ,. / LMiscellaneous
(service or feeder not included)
City/State/ZIP: 41 ( Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Phone:(� ) -2_ �' Fax:( ('+ /) D_--7/__ /(/
( Reconnect only 67.84 2
�1 Email:
\\ V�1�t♦ � 1 4� C - P,n„p or irrigation circle 67.84 2
/� CCB Lie.: �. rt Ele6trical Lic.- -3 ( Suprv.Lic.: /
l iiit I'� ��Sign or outline lighting 67.84 2
Suprv.Electrician signature,required: 6 ��f l Ir
Signal circuit(s)or limited-energy ❑ See Page 2 2
Print name: tp7 {� / L Date: + , 14 panel,alteration,or extension.
t' �{�i l( ii,:)
� Each additional inspection over allowable in any of the above
It
Authorized signature: \ Additional inspection(1 hr min) 66.25/hr
Print name: ' , V Date: I Investigation(1 hr min) 90.00/hr
' �r 1
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/5/CO /WEB .. /'�� Q
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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
9490 SW SATTLER ST, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00486
Jeff Grove
Violation Summary:
Inspector Contractor