Permit CITY OF TIGARD ELECTRICAL PERMIT
: 4 I ' COMMUNITY DEVELOPMENT Permit#: ELC2016-00900
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/22/2016
l�' k 1) 9 Parcel: 2S112BD90041
Jurisdiction: Tigard
Site address: 14655 SW 76TH AVE 4 -
Project: Timbercrest Condos,Unit#4 Subdivision: TIMBERCREST CONDO Lot: 4
Project Description: Electrical reconnect for Unit#4
Contractor: N/A Owner: US BANK NATIONAL ASSOCIATION TR
BY SELECT PORTFOLIO SERVICING INC
3815 SW TEMPLE
SALT LAKE CITY, UT 84115
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 11/22/2016 $67.84
Specifics:
1 ea 12%State Surcharge- 11/22/2016 $8.14
Electrical
Type of Use: MF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
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 ' accordanc ith 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: Orego law 'uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-00 -0010 through OAR 95 !
Electrical Permit Application FOR OFFICE USE ONLY
eived
City of Tigard DatRece/By: If 8 A//i, —t)k PPermit#: �/I n„`/,,e50 9696
III I n 13125 SW Hall Blvd.,Tigard,OR 97223 Review "�O� w vV
Phone: 503.718.2439 Fax: 503.598.1960 Ft Ec11 lc
Wale/BY
Related Permit#:
Inspection Line: 503.639.4175 "' Ready Date/By: Juris: H See Page 2 for
TIGARD
c Internet: www.tigard-or.gov � � �Q��Notified/Method: Supplemental Information
TYPE OF WORK t4
y PLAN REVIEW
❑New construction ❑Addition/alteration/re�? e®t F•Ile ,_ i'pp Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition /1 Other: ` t D¢9�y� 1�t� >; Ii 1S O ❑Service or feeder 400 amps or more ❑Building over three stories.
Fiii6l_DI1 `" where the available fault current 0 and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
1-and 2-familyless to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ dwelling ❑Commercial/industrial ❑Accessory building
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
Job 4: Job site address: 14655 SW 76TH AVE#4 ❑100H oo of ore motor load of system.
]OOHP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:TIGARD,OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.4:4 Project name: ❑Hazardous locations. 0 Supply voltage for more than
�! 13f e- -/ e✓ no
Lr—dvi`iS ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:76th FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision:TIMBERCREST CONDOS Lot#:4 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:R2148302 // Ea.add'l 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential 75.00 2
ELECTRICAL INSPECTION FOR RECONNECT (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
® PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name:US BANK NA SERIES 2007-FF1 C/O SPS AND BEN CAMPBEL 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,o excha ge,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature.lib_,_" __y ,it , 5/S Date: 1/)1 r))7-0(CD 401 amps amps .
ill APPLICANT CI CONTACT PERSON Branch circuitsto599 —new,alteration,or extensi168on54,per panel 2
A.Fee for branch circuits with
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name:BEN&CAROLYN CAMPBELL w/Premiere Property Group? B.Fee for branch circuits without
56.18 2
Address: 16420 SE McGillivray Blvd.Ste 103,PMB 834 service or feeder fee,first
branch circuit
City/State/ZIP:Vancouver,WA.98683 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)281-7653 Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:carolyn.benandcarolyn@gmail.com Reconnect only X 67.84 (01.?4_k 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. 0 See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP:
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:
Inspections for which no tee is 90.00/hr
CCB Lie.: Electrical Lic.: Suprv.Lic.: specifically listed(%hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 6.0;7,8`f
Print name: Date:
0 Plan Review Required(25%of permit fee): 41'4
State surcharge(12%of permit fee): .1SC
Authorized signature: TOTAL PERMIT FEE: .7 t ,le
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
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
14655 SW 76TH AVE 4, TIGARD, OR, 97224
Record Type:
Commercial - Electrical
Inspection Type:
199 Electrical final
Result:
PASS- NoCofO
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
Record ID:
ELC2016-00900
Inspector:
Jeff Grove
Contractor