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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2017-00364 TWARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/23/2017 Parcel: 1 S 136AB04900 Jurisdiction: Tigard Site address: 10349 SW 71ST AVE Project: MICHAEL Subdivision: MAPLELEAF Lot: 7 Project Description: (3)branch circuits for new bathroom in existing laundry room. Contractor: OWNER Owner: MICHAEL, JOHN W&LEESA I JOHN&LEESA MICHAEL 10349 SW 71ST AVE 10349 SW 71ST AVENUE TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503-752-0300 PHONE: FAX: FEES Quantity Description Date Amount 3 crt Branch Circuits wo/Purchase 05/23/2017 $71.02 Specifics: Service or Feeder 1 ea 12%State Surcharge- 05/23/2017 $8.52 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $79.54 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. ATTENTI•'. • -:.n law requires you to follow the rules adopted by the Oregon Utility Notification Center, Those rules are set forth in OA 952-001-0010 rough OAR 9 2-00 e:•.. .0 may obtain a copy of the rules or direct questions to OUNC by calling 503.232.198 .800.3344. '� � Issued B • ' Permittee Signature: ,#'_ , 7/ OWNER INSTALLATION ONLY The installation is being made on property I own itch is nordf ended for sal- lease•'rent. OWNER'S SIGNATURE k =�/ � / � Date: /4 /i7 I 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 � . FOR O,:,:,( , t '•,, ON11 City of Tigard q � -- L, Received Iiii • x Date/B : 7 I+/ 13125 SW Hall Blvd.,Tigard,OR 97223x' C Plan Review Phone: 503.718.2439 Fax: 503.598.1960 f Date/B : Related Permit#: A_ , )i 7 -, r Inspection Line: 503.639.4175 Read Date/B 1 1 G A R D Internet: Line:www.tigard-or.gov otified Method:y: l0 See Page 2 for CAI F Supplemental Information TYPE OF WORKr t+� CAI 1'xC nnom�}} CI* ' r" �1'*1.717E 11; PLAN REVIEW 0 New construction 0 Addition/alteration/ ,,e .4 ' ' Please check all that apply(submit 2 sets of plans w/items checked): '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. ❑ 1-and 2-family dwelling ❑Commercial/industrial ❑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 Job#: Job site address: /63 7 C Sl(1 '7 S f ❑Addition of new motor load of system. 1 /!(/1�'`2.t. , 100HP or more. ❑"A","E","1-2","1-3", City/State/ZIP: G-i �� 0 Six or more residential units. occupancy. i .' og / ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: ti Project name: ini(/r,e/ 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: FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 47 1 ,y " ���' yr P Z, ,J (with above sq.ft.) 75.00 2 I Limited energy,multi-family residential(with above sq.ft.) 75.00 2 1.,:r..,14 �l'-�-7 i Cry �z;/ 'Z e X S 75 r ;� L`r' uenewable Energy El See Page 2 © PROPERTYPROWNER r d a TEN ServicesRor feeders installation,alteration,and/or relocation Name: UG`i C c /ii_so_ /moi c/i 7 200 amps or less 100.70 2 Address: ( I 0 ' D 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 Email: Temporary services or feeders installation,alteration,and/or relocation Owner installation:This' stallati s ,is bein made on prop that I own which is not 200 amps or less 59.36 1 intended for sale,le.se, ,�t, •or ex. ,, - . ordin•, e ORS ,449,670,and 701./. 201 amps to 400 amps 125.08 2 / Owner signature: /_:22g, _,„./P-__.A,., Date: /C _,/' 2401 amps to 599 amps 168.54 2 [] AF° ICANT Q CONTACT PERSON Branch circuits—new,alteration,or extension,per panel 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 Address: service or feeder fee,first r branch circuit f 56.18 SI,i 3 2 City/State/ZIP: Each add'l branch circuit 7.42 pill 2 Miscellaneous(service or feeder not included) f Phone:( ) Fax: :( ) Each manufactured or modular Email: dwelling,service and/or feeder 67.84 2 Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: j' i d;°+l i. L, • f i r .e/ . Sign or outline lighting 67.84 2 i u. L, CRG✓tj'y Address: t ! ('/' li ?/ Signal circuit(s)or limited energy g d/,j +J 4�+ / S 4 .t j panel,alteration,or extension. ❑ See Page 2 2 City/State/ZIP: 1 s" •,/ Each additional inspection over allowable in any of the above r t' r 4 E C, k ` 7/�3 Additional inspection(1 hr min) 66.25/hr Phone:( 7.„),3) "2.51,7—c. 'c * Fax: �alti,,,! ( ) Investigation(1 hr min) 90.00/hr Email: �� ` Industrial plant(1 hr min) 78.18/hr f CC rC. " (� ) 7 ( Inspections for which no fee is CCB Lic.tf iElectricals c.: Suprv.Lic.: specifically listed(/2 hr min) 90.00/hr ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: '7/, �� Print name: f' �# /4 r j UAL� Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): �,5)-. Authorized signature: l ,L ZY. _,:t" TOTAL PERMIT FEE: '7 Y This permit application expires if a permit is not obtained within 180 Print name: t/'4X 4,fifilf,c‘fr.el Date: ,S /ZZ - days after it has been accepted as complete. 1 * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.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 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 ❑ 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 n 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('Vs hr min) ELECTRICAL. PERMIT FEE'S COMMERCIAL WORK ONLY: 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 ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PerntitApp_ELR_ERE.doe Rev 06/17/2015 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 10349 SW 71ST AVE, TIGARD, OR, 97223 Record Type: Record ID: Residential - Electrical ELC2017-00364 Inspection Type: Inspector: 199 Electrical final Jeff Grove Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor