Permit (47) CITY OF TIGARD ELECTRICAL PERMIT
a Y : COMMUNITY DEVELOPMENT Permit#: ELC2017-00395
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/30/2017
T[C A t3- g Parcel: 1 S 133DA01300
Jurisdiction: Tigard
Site address: 11105 SW SUMMER LAKE DR
Project: Cassinelli Subdivision: AMART SUMMER LAKE Lot: 35
Project Description: (7)branch circuits for kitchen remodel
Contractor: GENESIS ELECTRIC NW Owner: CASSINELLI, JAMES P&KATHY R
3753 KIENTHORPE WAY 11105 SW SUMMER LAKE DR
WEST LINN, OR 97068 TIGARD, OR 97223
PHONE: 503-303-8056 PHONE:
FAX: 503-303-8605
FEES
Quantity Description Date Amount
7 crt Branch Circuits wo/Purchase 05/30/2017 $100.70
Specifics: Service or Feeder
1 ea 12%State Surcharge- 05/30/2017 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 th 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. ' ` ENTION: Oregon -w -•.'res you to follow the rules adopted by the Oregon Utility Notification Center. Those rules ar-_-:-•"fo'rth in OA�3
952-00 -0010 through OAR 952 6! -0090. Y•- ay obtain a copy of the rules or direct questions to OUNC by calling 503.23 . 1.„10..8;1000
. 32",..i.
Issu- By: 1 ' ' /4*"lr�ieA___A��A i Permittee Signature: /C
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' 1 ✓ O /
�_�' ,- ✓his[ -c--- Date: �!',
LICENSE NO. 601\S-J Cj
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 USE Oy LI
CI` of Ti and Received 22��g Date/By: o /7 ( S;,n Permit No.: G (90/2—003 9 3
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
>s Phone: 503.718.2439 Fax: 503.598.1960DateBy: Other Permit:
TI G n 1i a Inspection Line: 503.639.4175 Date Ready/By: Juris El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
0 New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
(\1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
0 Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: Job site address: ////9s S O s'',VA'G'/f air.P/. Six or or more. occupancy.
6�C 0 Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: ,?J 624e j DVe ,722,3 0 Health-care facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: C'4S.S'//!Jf GG/ 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty, I Fee. I Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
1,000 sq.ft.or less 168.54 4
Subdivision: Lot no.:
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 75.00 2
Vr— �T,A.J A:71—,.-7 d,d7j-G residential(with above sq.ft.)
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
0 PROPERTY OWNER 0 TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
relocation
Phone:( ) Fax:( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation:This installation is being made on property that I own which is not
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Branch circuits—new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
1K APPLICANT 0 CONTACT PERSON above service or feeder fee, v 7.42 - - 2
each branch circuit
Business name: �f A,r65,s, j2t„C,7�/C, Al� B.Fee for branch circuits without 54.4 service or feeder fee,first
/
56.18 2
Contact name: ie. ,,,.7„, ''''.?, for,.,,,...55, branch circuit I
Each add'l branch circuit C 7.42 y5(Si 2
Address: /5:379 7 /L Of4.../ ,e)2 Miscellaneous(service or feeder not included)
?'G ®/7 Each manufactured or modular
City/State/ZIP:
D "460 /' 97? 9$ dwelling,service and/or feeder 67.84 2
Phone:,(SQ3) go ;?4.5.6. Fax: :( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: fai,S 7e/C A/id 0 /!lam/G .
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s)or limited-energy
r ��1� �� panel,alteration,or extension. Page 2 2
Business name:
��r`'S"'.3 C �C Each additional inspection over allowable in any of the above
Address: /6,379' r/e�f it/6. v/E� /</C Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: /� Investigation(I hr min) 66.25/hr
1.�,er 0 G/. c' 9'7O 4' S Industrial plant(1 hr min) 78.18/hr
Phone:( J) 3 p3 /kc6 Fax:(543) 3d3 86 Df-- Inspections for which no fee is
p Electrical Lic.: specifically listed(%1 hr min) 90.00/hr
CCB Lic.:
/�� 4 C‘,4 Suprv.Lic.:c.... .2,53;51ELECTRICAL PERMIT FEES 70
Suprv.Electrician signature,required: �� Subtotal: ��6.
vs. Plan review(25%of permit fee): p
`\` Print name: 1.--›../. / z Date:,...52t / State surcharge(12%of permit fee): 7,2. "
:s._ TOTAL PERMIT FEE: /�2. 7g
Authorized signature: �� "��
lJ3,� This permit application expires if a permit is not obtained within 180
Print name: days after it has been accepted as complete.
£/ j,,y��j Date:'1:e * Number of inspections allowed per permit.
I:\Building\Permits\ELC-PermitApp.doc 07/01/10 440-4615T(11/05/COM/WEB
,
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating,Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(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
O Instrumentation
❑ Intercom and Paging Systems
O 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-PermitApp.doc 07/01/10
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11105 SW SUMMER LAKE DR, TIGARD, OR, September 21 , 2017 at
97223 8:58:11 AM
Record Type: Record ID:
Residential - Electrical ELC2017-00395
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor