Permit (31) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT
Permit#: ELC2017-00362
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/22/2017
T[t "� Parcel: 25111 CB01601
Jurisdiction: Tigard
Site address: 15055 SW 100TH AVE
Project: BAKER Subdivision: MARGUERITE OCHS TRACTS,THE Lot: 1
Project Description: (4)branch circuits for bathroom remodel.
Contractor: TRI-CITY ELECTRIC Owner: BAKER, DAVID&MICHELE
8395 S. GRIBBLE 15055 SW 100TH AVE
CANBY, OR 97013 TIGARD, OR 97224
PHONE: 503-266-9995 PHONE:
FAX:
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo/Purchase 05/22/2017 $78.44
Specifics: Service or Feeder
1 ea 12%State Surcharge- 05/22/2017 $9.41
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 rul are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may o. -n a cop-f the rules or direct questions to OUNC by calling 50 32.1987 or 1.800.332. 44
Issued By: _ _ _ — Permittee Signature: Sr.-�11�`
40, 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 FOR OFFICE tSE()NIA
City of Tigard �r o Received permit#:
lig r13125 SW Hall Blvd.,Tigard,OR 97223 i��Y Plan Review �`7 r� 'f `}
�i �
0' Phone: 503.718.2439 Fax: 503.598.196 Related Permit#: //11 e '
q ��� DateBy: ����['�I�T...et)���r�,
T 1 GARD Inspection Line: 503.639.4175 p Ready Date/By: Juris: ® See Page 2 for!may
Internet: www.tigard-or.gov MR c l�trfied/Method: j' ...<, Supplemental Information
TYPE- , Oi+ ' _T4 '.`, � �� _ - '.- 1' 'O�
❑New construction ddition/alteration/re. .t tS• •`'" Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition 0 Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORYO exceeds 10,000 amps at 150 volts or 0 Floating buildings.
lc 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.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
`JOB"SITE:IN!)R ,'e41I 11i i.00A`jOAl 0 Emergency system. larger separately derived
Job#: Job site address: `� 0 Addition of new motor load of system.
�c<.7Sy3 5,.„{2 f 7 lt7J 100HPormore. ❑«A„«E„ «1.2„«1.3„
City/State/ZIP: ❑/� Six or more residential units. occupancy.
��4/- ✓ �'!-��,E?� 9 2 Z-z y 0 Health-care facilities. ❑Recreational vehicle parks.
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: '_,
Description I Qty. I Each 1 Total
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
' Tl0 WORK', . -. v . ,. . Limited energy,residential
1115 o iT g l/7N (with above sq.ft.) 75 00 2
7� Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy
0 See Page 2
0 PI kP dimwit . - _ , , 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 l
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
� � �� A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit / , ' l r
City/State/ZIP: Each add'l branch circuit a 7.42 )),._. ti 2
Phone: Miscellaneous(service or feeder not included)
( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder
Email: 67.84 2
_ Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Business name:( .-.6,f G7 !0 iefL Sign or outline lighting 67.84 2
Address: n �� Signal circuit(s)or limited-energy 0 See Page 2 2
p, 1 9 A / panel,alteration,or extension.
City/State/ZIP: 9-.70 > Each additional inspection over allowable in any of the above
r �y 62,2_
% 0,J Additional inspection(1 hr min) 66.25/hr
Phone:(5-P.3') .�c'- 71'1'�� Fax:( ) Investigation(1 hr min) 90.00/hr
�t
Email:40 / �� � 7 ' 0,...),,1 Industrial plant(1 hr min) 78.181 hr
Inspections for which no fee is 90.00/hr
CCB Lic.: ElectricalLic.:" ) Suprv. �`' specificallylisted(%hrmm)
G`�t��, l!� yy O i;.G p Z _, .„TILES i 4x,,r,s q.,,J ,. .
Suprv.Electrici2rlr 3/iJature,required: r �/°j l 1 IBJ r (t
47411 i✓ (r�,� y..,2._ Subtotal: 7�':ii y
Print name:7�1 `� Date: tI 0 Plan Review Required(25%of permit fee): /
State surcharge(12%of permit fee): 41. it/
V.
Authorized signature: TOTAL PERMIT FEE: 7,
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
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15055 SW 100TH AVE, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Electrical ELC2017-00362
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor