Permit (9) CITY OF TIGARD ELECTRICAL PERMIT
ifilr` Permit#: ELC2017-00213
COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/28/2017
T[ - Parcel: 2S103AA02400
Jurisdiction: Tigard
Site address: 12270 SW 106TH DR
Project: Lefever Subdivision: CLYDESDALE Lot: 5
Project Description: (12)branch circuits for kitchen remodel.Panel work to be done under separate permit.
Contractor: WILL LEFEVER Owner: LEFEVER,WILLIAM JAMES
12270 SW 106TH DR 12270 SW 106TH DR
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 971-998-7254 PHONE: 971-998-7254
FAX:
FEES
Quantity Description Date Amount
12 crt Branch Circuits wo/Purchase 03/28/2017 $137.80
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/28/2017 $16.54
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $154.34
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 a < •- 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. AT ' TION: Orego law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-r 010 through OAR 95-001-0h9• ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued ' �L / ! / Permittee Signature: i,
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent. 2
OWNER'S SIGNATURE Date:*C/e/7
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 rok nrr►( L l SE Oyl
City of Tigard ;t I t I ,. Received -
r 1" '.. z Date/B61 CrPermit#: El-C- 1— 60,-i
13125 SW Hall Blvd.,Tigard,OR-9'7722S" Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175 M/•,R 2 8 i i Ready Date/By: Julie' H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE Pi i a .,A li!) PLAN REVIEW
New construction ®Addit,,lopia1tef Qllir£p1J CIII�titr",-.; 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.
❑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.
® 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 0 Emergency system. larger separately derived
❑Addition
Job#: Job site address:12270 SW 106th dr. Hof new motor load of system.
100HP or more. ❑"A">"E","1-2","1-3",
❑Six or more residential units. occupancy.
City/State/ZIP:Tigard Oregon 97223 0Recreationa
Recreational vehicle parks.❑Health-care facilities.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:Tiedeman Ave and Walnut FEE SCHEDULE
Description I Qty. I Each 1 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#:2S103AA02400
Ea.add'►500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
Kitchen Remodel
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
PROPERTY OWNER 0 TENANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name:Will Lefever 200 amps or less 100.70 2
Address: 12270 SW 106th dr 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard Oregon 97223 601 amps to 1,000 amps 301.04 2
Phone:(971)9987254 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: /&-4vea-ov;1/ & yy4 co, co M 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:( L Date: 2-2 r—/7 401 amps to 599 amps 168.54 2
0 APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name:Will Lefever B.Fee for branch circuits withoutse
Address: 12270 SW 106th dr branche or feederstfee,first / 56.18 '6-6•t ' 2
branch circuit
City/State/ZIP:Tigard Oregon 97223 Each add'l branch circuit 11-17 7.42 ?/.(,p _2
Miscellaneous(service or feeder not included)
Phone:(971)9987254 Fax: :( ) Each manufactured or modular 67.84 2
Email:lefeverwill@yahoo.com dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: d aD, alf?_ Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: Electrical Lic.: Suprv.Lie.: specifically listed(t/z hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: / 37.cio
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): lb .s it
Authorized signature: TOTAL PERMIT FEE: 1 641,39
This permit application expires if a permit is not obtained within 180
Print name: ' 0,.---e. Date: g_2_7_, , days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR ERE.doe Rev 06/17/2015 440-4615T01/05/COM/WEB