Permit (49) CITY OF TIGARD ELECTRICAL PERMIT
'y COMMUNITY DEVELOPMENT Permit#: ELC2016-00504
Ti G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/21/2016
Parcel: 1S133DD15200
Jurisdiction: Tigard
Site address: 12862 SW VILLAGE PARK LN
Project: Mullens Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 189
Project Description: (1)branch circuit for a/c install
Contractor: WEBER ELECTRIC INC Owner: MULLENS, MARYANNE C
7007 SW ROBBINS RD 12862 SW VILLAGE PARK LN
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503-819-7380 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 06/21/2016 $56.18
Specifics: Service or Feeder j
1 ea 12%State Surcharge- 06/21/2016 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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. ATT • •N: •r •n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001 ,010 through OAR 9 .01-4'90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.23 .
Issu_d By: k , _ Permittee Signature: Lt t 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' ` AkIII r 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 ApplicatR[C "I 1.014 of i iti.: I Sl:O\l.1
City of Tigard ReceivDateBea „INS . ( Permit#: EL r,...9614 _pp 56
im 13125 SW Hall Blvd.,Tigard,OR 972.121 n 1 PlanReview
Phone: 503.718.2439 Fax: 503.598. 19d 2016
Date/B : Related Permit#: ` t C —0.3(r/
Inspection Line: 503.639.4175y �} Ready Date/By: Juris: H See Page 2 for
T I(i A E I) Internet: www.tigard-or.gov C1 1g�^1V OF [2CARD Notified/Method: Supplemental Information
TYPE B1 1NSy DIVISION PLAN REVIEW
0 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 ElBuilding over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
1 CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-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 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 12862 SW Village Park Ln 100HP or more. ❑"A","E","t-2","t-3",
City/State/ZIP:Tigard,OR 97223 0 Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: tl`'t U L LEIJS 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 Qty. 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.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
1 circuit for A/C (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 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
0 APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,eer 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
Address: service or feeder fee,first 1 56.18 56.1 8 2
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
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Weber Electric,Inc Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 See Page 2 2
Address:7007 SW Robbins Rd panel,alteration,or extension.
City/State/ZIP:Tualatin,OR 97062 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)819-7380 Fax:( )na Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:weberelectricl@gmail.com
Inspections for which no fee is
CCB Lic.: 44087 b'4/Il Electrical Lic.: 34-442C Suprv.Lic.: 4028S
specifically listed(%s hr min) 90.00/hr
�fi� ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:-i�Z�lC i Subtotal: 56.18
Print name: Matt Weberr Date ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 6.74
Authorized signature: TOTAL PERMIT FEE: 62.92
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 permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Location:
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Inspection Date:
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Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12862 SW VILLAGE PARK LN, TIGARD, OR,
97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00504
Chip Barnett
Violation Summary:
Inspector Contractor