Permit (105) CITY OF TIGARD ELECTRICAL PERMIT
!Aro-
:L., COMMUNITY DEVELOPMENT Permit#: ELC2017-00559
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/26/2017
TIGARD
g Parcel: 2S 110AD90029
Jurisdiction: Tigard
Site address: 14888 SW 109TH AVE
Project: Cadigan Subdivision: CANTERBURY WOODS CONDO Lot: 29
Project Description: Electrical reconnect only
Contractor: N/A Owner: CADIGAN, SCOTT
CADIGAN, RYAN
14888 SW 109TH AVE
TIGARD, OR 97224
PHONE: 503-704-5909
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 07/26/2017 $67.84
Specifics:
1 ea 12%State Surcharge- 07/26/2017 $8.14
Electrical
Type of Use: MF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports(Conditions)
This permit is is -• •'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done i =ccordance with .•proved •lans. This permit will expire if work is not started within 180 days of issuan e, or if work is suspended for more the 180
days. A ENTION: Oregon la, r-•ui -s ou to follow the rules adopted by the Oregon Utility Notification /enter. Those des are set forth in OAR
952-001 0010 thro,h OAR 952-0s-0090.Y may obtain a copy` the rules or direct questions to OUNC by calling 503.23'.1987. 1.8 .3 ., 44/
Issue. :y: Permittee Signature: A
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 01-Fl('L I. I,0NI.l
City of Tigard ReceReceiv Ate/1 Am Permit#: E�.tdol i-GID 55
'PI13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Juris: ® See Page 2 for
l l('A R 1) Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ❑Addition/alteration/replacement 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.
O 1-and 2-family dwelling ❑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 of new motor load of system.
Job#: Job site address: /y'7g S',t), 10 At" 10OHP or more. ❑"A","E","1 2","1-3
City/State/ZIP: (,--\\I 01? q asC-� 0 Six or more residential units. occupancy.
0
)� 1 ❑Health-care facilities. Recreational vehicle parks.
Suite/bldg./apt.#: Project name: CCA IA [.J stir y j Li i,o 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 ITotal 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#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
L--LE,erg t e.-I-e.... 2i_e-O/J/J (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
0 PROPERTY OWNER 0 TENANT, Services or feeders installation,alteration,and/or relocation
Name: C 0 .ii L, CoAt(3av\ 200 amps or less 100.70 2
Address: ' 4 \/J 10911 AVS 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: l'ij 3 cAr, ) Q g, ci ��l 601 amps to 1,000 amps 301.04 2
Phone:( ' 3 ) -7 o Z(-. 5(16 9 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 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: Date: 401 amps to 599 amps 168.54 2
0 APPLICANT ❑ 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 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only f 67.84 4 7/2
C CTOR Pump or irrigation circle / 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: /4— 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 Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(%hr min)
ELECTRICAL PERMIT FEES '
Suprv.Electrician signature,required: Subtotal: `p 7 ks/
Print name: Date: 0 Plan Review Required(25%of permit fee): `
State surcharge(12%of permit fee): X ./51Authorized signature: ��� TOTAL PERMIT FEE: 7'S
This permit application expires if a permit is not obtained within 180
days accepted Print name: 5C 01/ [ , (1-la i o 011,- Date: ?-‘,16-/-.7after it has been as complete.�
J * Number of inspections allowed per permit.
I:)Building\Permits\ELC_PermitApp_ELRERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
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City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14888 SW 109TH AVE, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Electrical ELC2017-00559
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor