Permit CITY OF TIGARD ELECTRICAL PERMIT
1 :'�COMMUNITY DEVELOPMENT Permit#: ELC2016 00514
Date Issued: 06/23/2016
TIGARD.R 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S102CD02708
Jurisdiction: Tigard
Site address: 13560 SW ASH AVE
Project: Pieren Subdivision: FREWING'S ORCHARD TRACTS Lot: 26
Project Description: Replace 125a panel and add(4)branch circuits for split load
Contractor: OWNER Owner: PIEREN, NATHANIEL&NICOLE A
NATANIEL&NICOLE PIEREN 13560 SW ASH ST
13560 SW ASH AVE TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-522-2582 PHONE: 503-522-2582
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 06/23/2016 $100.70
Specifics: amps or less
4 crt Branch Circuits w/Purchase 06/23/2016 $29.68
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 06/23/2016 $15.65
Electrical
Type of Const:
Occupancy Grp:
Total $146.03
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 rdance I_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: Oregon rw • ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-0 -0010 through OAR 95 •r -009•. •u may obtain a copy.f the rules or direct questions to OUNC by calling 503.2332.1987 or 1.800.332.2344
•
Is ued By: /2'� i 4 ' Permittee Signature: /(-� 2.1� �� J��
_/ OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for ,lease or rent. -
OWNER'S SIGNATURE _Ar.�-CLJ-S- -�OJ19a-/- /
Date: '-P /41-3
/ce,
-
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 Permi, t AUplicat 1 k i FOR OFFICE USE ONLY ��y
City of Tigard —I - ' Received Ii a3 /6 6T /}t Permit#: /�p'W57V
DateBy: ���JA'�
111 "I 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598..1;1¢,Q, fi cy m()i t- Date/By: Related Permit#:
Inspection Line: 503.639.4175 IN Go ,,, Ready Date/By: loris: ® See Page 2 for
TI G A K D Notified/Method: Supplemental Information
Internet: www.tigard-or.gov `--
X ¢ qa
.P,:iii1.71A17411::::41P,i0(e'„if iir3L11527:7 4A
7 e 7 iii N 7:72i 11 ,t a r: (1 . 4 ,. ,4 '#4^,- .a 4 ire,o':,:
❑New construction ®Additioit4itaiOne t '
Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more El Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
s_ ' ! * , exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or
IiIa a n y� '�= * o g" ❑Emergency system. larger separately derived
- -- m � ' ' �w ❑Addition of new motor load of system.
Job#: Job site address: 13560 sw ash ave 100HP or more. 0"A","E","1-2","1-3",
❑Six or more residential units. occupancy.
City/State/ZIP:Tigard,or,97223 0 Health-care facilities. ❑Recreational vehicle parks.
❑Hazardous locations.
0 Supply voltage for more than
Suite/bldg./apt.#: Project name:
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:Frewing iliZnat " 4 : 'li ih, ' 'r —
r
Description Qty. I Each I Total •
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'l500 sq.ft.or portion 33.92 1
r 6, o s
1 ! i r 'a ' to Limited energy,residential
75.00 2
(with above sq.ft.)
Replace 125A electrical service panel
Limited energy,multi-family 75.00 2
Add 4 additional circuits to split loads
residential(with above sq.ft.)
t. Renewable Energy 0 See Page 2
s �+ ill. fir: al➢r,i,w1;
i., 0 ' i" _ 1 . ;� ,_ ' = ter i -r® ?,Ni'fiP Services or feeders installation,alteration,and/or relocation
Name:Nathaniel Pieren 200 amps or less 1 100.70 100.70 2
Address: 13560 SW Ash Ave 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,Or,97223 601 amps to 1,000 amps 301.04 2
Phone:(503)522-2582 I 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 isnot 200 amps or less 59.36 1
intended for sale,lease, nt,G/ ttge,acc ' g to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 2?.//t` 401 amps to 599 amps 168.54 2
Elypt! a- , „f,!,:-, 1,11'��n a rAwc Branch circuits—new,alteration,or extension,per panel
! �i ` � ���r` ,,,��i� � - x . A.Fee for branch circuits with
Business name: above service or feeder fee, 4 7.42 29.68 2
each branch circuit
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:( ) I Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
. .. ! tE ;;, „t„ E' Pump or irrigation circle 67.84 2
Business name: CO �, Sign or outline lighting ' 67.84 2
Signal circuit(s)or limited-energy I ❑ See Page 2 2
Address: panel,alteration,or extension. r
Each additional inspection over allowable in any f the above
City/State/ZIP: Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(I hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:
Inspections for which no fee is
CCB Lic.: Electrical Lic.: 90.00/hr
s.ecificall listed(%2 hr mm
Suprv.Lic.: �� ,
o. 17 2 '. . n i s§� --i ,i
Suprv.Electrician signature,required: Subtotal: 130.38
Print name: I Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 15.65
TOTAL PERMIT FEE: 146.03
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 permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
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
13560 SW ASH AVE, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00514
Jeff Grove
Violation Summary:
Inspector Contractor