Permit 111114
CITY OF TIGARD ELECTRICAL PERMIT
2 ' COMMUNITY DEVELOPMENT Permit#: ELC2016-00789
T[GAR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/11/2016
Parcel: 1 S 125D B 11300
Jurisdiction: Tigard
Site address: 7440 SW ELMWOOD ST
Project: Carlson Subdivision: ELMWOOD PARK Lot: 7
Project Description: (1)branch circuit for covered porch.
Contractor: PRIMARY ELECTRIC LLC Owner: CARLSON LIVING TRUST
371 SE 13TH PLACE BY CARLSON, CAROLEE T TR
CANBY, OR 97013 7440 SW ELMWOOD ST
TIGARD, OR 97223
PHONE: 503-703-5989 PHONE: 360-513-2746
FAX:
FEES
Quantity Description Date Amount
Specifics: 1 crt Branch Circuits wo/Purchase 10/11/2016 $56.18
Service or Feeder
1 ea 12%State Surcharge- 10/11/2016 $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, o 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 Those rules are set forth in OAR
952-001-0010 through 0 952-0* -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 5d3.232 1,;7• 1.800.332.2344.
` ' , ^ A
Issued By: �,
` 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' 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 `.,- ',- 4 '..'-' - ;1' ,,n 4 : FOR 0111( 1. l I. ONI 1
City of Tigard Received .,,
DatelB : le / ,/ ,.. ." it,, 'ermit#&°--Z-C /6 -00 1 1 2, 4'
. 13125 SW Hall Blvd.,Tigard,OR 97223 1 1 r-i 2 fl 1 f,-, Plan Review
III 111 Phone: 503.718.2439 Fax: 503.598j960 J'' I '''' -"''' Date/B Related Permit#:
Inspection Line: 503.639.4175 , _. Ready Date/By: Juris: IZI See Page 2 for
TIGARD Internet: www.tigard-or.gov "1, , , . Notified/Method: Supplemental Information
TYPE OF veitiltDI16'DIVISION PLAN REVIEW
0 New construction Er 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.
0 Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
2:11-and 2-family dwelling El Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 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:114AT.) e:-)( ) /1 t-1..03 a)v-) ""Ez:'-f 100HP or more.
0 Six or more residential units. occupancy.
City/State/ZIP: —V 4%n4.z.._,
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ,c4-2j,,,, NG, 4, 0 Hazardous locations. 0 Supply voltage for more than
Cross street/directions to job site: J 0 Service or feeder 600 amps or more. 600 volts nominal.
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
75.00 2
A 0 o 2_ c' 1,-Ls A,,,,ej PA r\_) (with above sq.ft.)
Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
OUTGel--
, Renewable Energy 0 See Page 2
0 PROPERTY OWNER U TENAN'r 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
Branch circuits-new,alteration,or extension,per panel
0 APPLICANT 0 CONTACT PERSON
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name:
B.Fee for branch circuits without
service or feeder fee,first
Address:
branch circuit 56.18 2
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
67.84 2
Email: dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: ve...,,,,m,„- f „---,„ , ,-,... 1.„...A.-' CSign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy
r2-51 ( i,: 1341 ,(4- -cf. panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: C/1,....j(.,1 (3 C-- c'-17 Each additional inspection over allowable in any of the above D 1 Additional inspection(1 hr min) 66.25/hr
Phone:6 )-2 D.3 = q C)'5 Fax:( ) Investigation(1 hr mm ) 90.00/hr
Email: A‘j ex A 0,,,c. c-c,,,,A,
CCB Lic.: (<-1,?,_i ci 'Electrical Lic.: Co),t't Suprv.Lic.: Srs S oc) :.
Industrial plant(1 hr min)
Inspections for which no fee is
specifically listed(V2 hr min) 78.18/hr
90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: I li ,(,4 t,, .,
,,,.. tJi.,,l, v •
Subtotal: „5-6, j42
Print name: Sco-c-c- - - . ,.. ) Date: (0-i( 110 0 Plan Review Required(25%of permit fee):
r)A
,-N
State surcharge(12%of permit fee):
TOTAL PERMIT FEE: 6,.2, 9 .
Authorized signature: , )s
Print name: TT ,oe z si,
,Lu\....
Date: i..t).--a 1(q This permit application expires if a permit is not obtained svithin 180
days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ER).doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. I Each I Total I
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
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
TI Garage Door Opener* >100 kva(fee in accordance
552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
El 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 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONL Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
El Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015
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
7440 SW ELMWOOD ST, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00789
Jeff Grove
Violation Summary:
Inspector Contractor