Permit (100) CITY OF TIGARD ELECTRICAL PERMIT
;• • it COMMUNITY DEVELOPMENT Permit#: ELC2017 00641
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/29/2017
Parcel: 28111 CC13200
Jurisdiction: Tigard
Site address: 10295 SW HIGHLAND DR
Project: CARRINGTON Subdivision: SUMMERFIELD NO.4 Lot: 183
Project Description: (7)branch circuits.
Contractor: ONE WEST ELECTRIC LLC Owner: CARRINGTON, RENEE M
575 BROWN CT 10295 SW HIGHLAND DR
WOODBURN, or 97071 TIGARD, OR 97224
PHONE: 503-807-8188 PHONE:
FAX:
FEES
Quantity Description Date Amount
7 crt Branch Circuits wo/Purchase 08/29/2017 $100.70
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/29/2017 $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 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: Oreg.' law requires you follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 9%2-001-0r,s.. You m • -'. .cy-: of tiff rules or direct questions to OUNC by calling 503.232.1 or I.:00.332.7,44
Issued By: / Permittee Signature: ✓
l/
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 USE ONLY
„ix'Ni....:
City of Tigard Received p �( L�
l° Date/By: / 2 /� �� Permit 4: ZL . 0/ 6,6'1
ilii
-'t 13125 SW Hall Blvd.,Tigard,OR 972'w,- Plan Review
11' ' Phone: 503.718.2439 Fax: 503.598.1 0 41(ill° Date'By: Related Permit �.�(7-006.Gi/
TIGARD Inspection I,me: 503.639.4175 \\� id ` a. ' Ready Date/By: Saris 0 See Page 2 for
Internet: wxh w.tigard-or.goV > � Natrfied/Method: Supplemental Inform ation�
{ "'CCC... '+((t�\7\C-*
TYPE OF WORK , PLAN REVIEW
❑Ness construction Addition/altel'ation/r 1, Please check all that apply(submit 2 sets of plans w�items checked).
\� fey ❑Service or feeder 400 amps or more ❑Building Deet three stories
❑Demolition Other: -
where the available fault current ❑Marinas and boas aids.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
il
Fit I- n2- amily dwelling ❑Commercial/industrial
o tm rci l/industrial ❑Other:
building tensroground,orexceeds 14,000 ❑Commercial-usea«ncnitnral
amps for all other installations. buildings.
❑ Multi-family ❑ ❑ ❑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: /6 LOC S(,.. 4i1L1a.,,k ny tOOHP or more.
(� j1 �}
0 Six or more residential units. occupancy
City/State/ZiP: -- t
r o/� Projecname: �,��
ay `1�1 Zq ❑Healthcare facilities. 0 Recreational schicic parks.
Suite,bldg.•/apt.#: V
r .e0 Hazardous locations. 13Suppl} voltage for more than
❑Service or feeder 600 snips omore. 600 salts nominal.
r
Cross street/directions to job site: FEE SCHEDULE
Description j Qts. I rai h I tool i .j-- ).
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: includes attached garage.
1,000 sq.It or less 165.54 j j 4
Tax map/parcel 4:
Fa.add'I 500 sq.ftor portion 33.92
DESCRIPTION OF WORK — (
Limired energy,residential
�1-cer CI f OA)� Wt � (with above sq.ft.)i 75.00 —-
S2V UtC�f3YF2@� Limited energy,multi-family �
4� /yahCt
/ residential(with above sq It.) 75.00 3
t diet ,�S Renewable Energy 1:1 See Page 2 t
PROPERTY OWNER 0 TENANT
Services or feeders installation,alteration,and/or relocation
Name: A‘\))F (' yr f >/1 200 amps or less _ 100.70 _ 3 it
�
Address: IO Zq� DA) Ili,14„,,,W 301 amps to 400 amps 33.56
/ 401 amps to 600 amps 200.34 . 2
/; a y
City/Slate/ZIP: d "C�Q(J Q6-L �ZZ� 601 amps to 1,000 amps 301.04
Phonc_(�7/ ) �q Zyn Fax:( ) Over 1,000 amps or volts T--52.2i; 2
Temporary services or feeders installation,alteration,and/or
Email: relocation 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 12,4.08 2
Oxvner signature: ___ Date: 401 amps to 599 amps 168.54 2
APPLiCAN i Branch circuits-new,alteration,or extension,pe and
❑ ❑ CONTACT l?1;RSON —
A.Fee for branch circuits with 7
Business name: /LQ .de I 0.` 6jyUc-fiev) above service or feeder fee, 7 42 2
each branch circuit
Contact name: )'.S , B.Fee for branch circuits 1'ithnitt
service or feeder fee.first
Address: to gOk /I;6, branch circuit 36.i 3 c�•/0F
2
Each add.I
rty/Slate/ZIP:r le OfWC�a at 97O3 _ Nlisce Ian ousch(serviccircuit
e or feeder not ncluded) -�� L
Phone: D �^ Fax: :rIrr
(� ) 76J 7�,� V6) ) C3�O OPqp Each
_ manufactured ormodular
67 84 dwelling,service and/or feeder2
1Fnlail: _ l -)l,Z �ee oGII, Cal/14 Reconnect only �51 3
_
� 1) ,
CONTRACTOR
Pump or irrigation circle 67 51 3 12
Business name: (4,,e, w�5f -etec6,�, Sign or outline lightin6784 )
vvv��� Signal circuit(s)or limited-energy
_Address: ;-.4-5--- 62.2,..,,,„,..)62.2,..,,,„,..) �(4_ , /��� 0;L �, (."2/panel,�7/panel,alteration.or extension. ❑ Sec Page 2 2
(."2
Each additional inspection over allowable in any of the above e,
City/State/ZIP: -- - — ,�
Additional inspection(I hr min) 6635/hr
Phone:(9 ) 8-07"-•-X/ -1? Fax:( ) Investigation(1 hr min) 00.00/hr
a / t ,C we5' ek 5,/-/c e Ce7�
Industrial plant(I hr min) 78.18/hr
I,mail: ( (� /
!U��I(°1 Inspections for which no fee is 90.00/hr
(.CI3 Lic.: Z/ ?9 _ Electrical Lic.: /a Q 6 Suprv. Lic.• r�0�s specifically listed('/z hr min)
�� �1 ELECTRICAL PERMIT FEES
Suprv. Electrician signature.required: i I r
_ �i Subtotal' -0.0,7 0
Print nante:oii-ip �� ,iet j//� Date: 2f 1 _❑Plan Review Required(25%of permit fee): -
a — State surcharge(12%of permit fee): 12..,O r
TOTAL PERMIT FEE:
Authorized signature• I(2�7F
1 This permit application expires if a permit is not obtained within 180
Print Hanle: . y Date: (c ._ode^/ I days after it has been accepted as complete.
* Number of inspections allowed per permit.
I Building PeruuuSs[1.1 PeuuuuiiApp Fl S [RE.doc Rev 06/17/2015 440.4615T(i i 05/COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10295 SW HIGHLAND DR, TIGARD, OR, 97224 October 23, 2017 at
10:38:12 AM
Record Type: Record ID:
Residential - Electrical ELC2017-00641
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor