Permit Support Document (26) CITY OF TIGARD ELECTRICAL PERMIT
7111 .`' COMMUNITY DEVELOPMENT . !"' a „[
Permit#: ELC2017-00148
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 w �� "M Date Issued: 03/02/2017
TE Aft. 9
s '`' �7 Parcel: 2S102AB90004
C> Jurisdiction: Tigard
Site address: 9210 SW CENTER ST 4
Project: House Happy Subdivision: WILLOW BEND CONDO,THE Lot: 4
Project Description: Re-route kitchen circuits,replace ceiling heat with wall fan forced heaters. 3/15/17:REPRINTED permit to add(1)
branch circuit for microwave.
Contractor: OMNI ELECTRIC INC Owner: IMPAC FUNDING CORP TR
16670 SW WRIGHT ST BY EDMONDSON, SHARON
BEAVERTON, OR 97007 19500 JAMBOREE RD
IRVINE, CA 92612
PHONE: 503-747-0805 PHONE:
FAX: 503-649-2709
FEES
Quantity Description Date Amount
7 crt Branch Circuits wo/Purchase 03/02/2017 $100.70
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/02/2017 $12.08
Type of Use: MF Electrical
Class of Work: ALT 1 crt Branch Circuits w/Purchase 03/15/2017 $7.42
Service or Feeder
Type of Const: 45 Misc Administration Fee 03/15/2017 $45.00
Occupancy Grp: 0 ea 12%State Surcharge- 03/15/2017 $0.89
Electrical
Total $166.09
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. 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 OAR 952-001-0090. You may obtain a co the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332,2344.
Issued By: � � i�••6"� T 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 C A r(Irz 01ltl: l `,l (1M.,
City of Tigard " ' Awed Permit#
13125 SW Hall Blvd,Tigard OR 97223 Datemr. 3/1.5-/,? j 7-II)/Lig
®
li C Phone: 503.718.2439 Fax: 503.598.1960 t'� PD Review
Related permt#:
Inspection Line: 503.639.4175 Q�
T I G A R D Internet: Line:g .gov a r i eiboay': Anis' 0 See Page 2 for
11"�� v6+, t I Supplemental Information
Ys, 01t� k1'��
TYPE OF WORK �' v c3 1 1 PLAN REVIEW
❑New construction ►:1 Addition/alteration/ -,,,t: :,F'' Please check all that apply(submit 2 sets of plans w/items checked):
, m.-s .''I 0 Service or feeder 400 amps or more 0 Building over three stories.
❑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.
El and 2-family dwelling 0 Commercial/industrial ❑Acc- t r uild less tO ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all otherinstallations. buildings-
®Multi-family 0 Master builder
0 Other: ❑Fire pump.
0 installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: I Job site address:9210 SW Center St 0 Addition of new motor load of system.
100HP or more. ❑ A E,"I-2", 1-3
City/State/ZIP:Tigard,OR 0 Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.it: Ci I Project name:House Happy 0 Hazardous locations. 0 Supply voltage for more than
Cross street/directions to job site: ❑Service or feeder 600 ampsor more. 600 volts nominal.
FEE SCHEDULE
Description I Qty. J_. Each I Total I >
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel if: 1,000 sq.ft.or less 168.54 4
DESCRIPTION OF WORK Ea-add'1500 sq.ft.or portion 33.92 1
Limited energy,residential
Microwave circuit (with above sq. ?5.00 2
ft)
/ r Limited energy,multi-family 75.00 2
( 1 y G(A/ residential(with above
f t 3.171-r Jc ,t,,a�.,,l.)1 sq.ft.)
0 PROPERTY OWNER AN1 Renewable Energy ❑ See Page 2
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
City/State/ZIP: 401 amps to 600 amps 200.34 2
I 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 I I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 1 I 125.08 Owner signature: Date: 401 amps to 599 amps 168.54
I22
APPLICANT; ! 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
Business name: — A.Fee for branch circuits wrrfi
above service or feeder fee,
Contact name:
• each branch circuit 7.42 2
8$> ss: — service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit i 7.42 7i().., 2
Phone ( ) I Fax::( ) Miscellaneous(service or feeder not included)
Each manufactured or modular
Email' dwelling service and/or feeder 67.84 2
CONTRACTOR Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Business name:Omni Electric Inc Sign or outline lighting 6784 2
Address:16670 SW Wright St Signal circuit(s)or Limited energy
panel,alteration,or extension. 0 Page 2 2
City/State/ZIP:Beaverton,OR 97007 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)747-0805 I Fax:
( ) Investigation(1 hr min) 90.00/lir
Email:omni_electric@hotmail.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 9000/6r
CCB Lic.: 176615 I Electrical Lic.: c297 I Suprv.Lic.: 4270s specifically listed(V2 hr min)
Suprv.Electrician signature,required: /� ,/ ELECTRICAL PERMIT FEES
r� ��t Subtotal: 1-ti,j.==1—
Print name: John M.Kelso ((((//// I Date: 3/15/17 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): (
Authorized signature: TOTAL PERMIT FEE:II) a
IPrint name: I Date: 3/15/17 ITis permit application expires if a permit is not owithin 180
days after it has been accepted as complete.
' Number of inspections allowed per permit
I:\Bulding\Permits1E.C_PenninApp ELRERE.doe Rev 06117/2015 440.4615T(11/05/COM/WEB