Permit (103) , CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT
Permit#: ELC2017-00647
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/31/2017
Parcel: 2S110AD90001
Jurisdiction: Tigard
Site address: 14820 SW 109TH AVE
Project: Sanchez Subdivision: CANTERBURY WOODS CONDO Lot: 1
Project Description: (2)branch circuits for heat pump hook up.
Contractor: NORMANDIN ELECTRIC Owner: SANCHEZ, SYLVIA
51086 NW CLAPSHAW HILL RD 14820 SW 109TH AVE
FOREST GROVE, OR 97116 TIGARD, OR 97224
PHONE: 503-357-5380 PHONE:
FAX: 503-357-4878
FEES
Quantity Description Date Amount
Specifics: 2 crt Branch Circuits wo/Purchase 08/31/2017 $63.60
Service or Feeder
1 ea 12%State Surcharge- 08/31/2017 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 rules are set forth in OAR
952-001-0010 through OA 001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �1 .'. � Al �T�'
1 Permittee Signature: ,C-/ '�f-7'"/(J
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.
, Eis _itieai PermitApplicationRecd
. . I.); 1 If 1 1 ,-.1 ()N,,1 '‘ .
II City of Tigard
, 13125 SW Hall Blvd.,Tigard,OR 97223 I-"By: O :g/ALIT4 -' C 4:
° Phone: 503.718.2439 Far 503.598.1960 'Ian Review
,,\.03 Data t : Related Penult/17k-e;‘,70/7--6eZ5`74,
, ,, ,, InSpection Line: 503.639,4175
,,, IT TA 1F.*"i„.11'elBY: jUTIV El See Free 2 for
° '"i Internet: www.tigard-or.gov
-,. si Oki r t k ' ."-''''.. "''• , SUPPleateetal neormation
TM OF WORK I wilciCi ,' '' PLAN tLEVIEW
0 New construction 13 Addition/alteration/repld4titit.''' '' Please titter-kali that apply(submit Isms of plans wirtems cheeked)-
0 Demolition 0 Other: 0 Service or feeder 400 amps or more 0 Building over three stones.
where the available fault current 0 Marinas and boatyards
l CATEr.,ORY OP CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
2r1-and 2-family dwelling 0 Cortunercial/industrial 0 Accessory building less to round,or exceeds 14,000 Q Commercial-use agricuitural
amps for all other installations buildings,
0 Multi-family 0 Master builder 0 Other:
0 Fire ptmnp. 0 Installation of 150 KVA or
JOB SITE INFORMATION LOC TION .0 Emergency sYstem- larger seParsielY derived
Job#: I Job site address: 14, 4. to /01417 gve, odlkooddnalomf:erew.motor
load
of ' 0,.$77$.$E-,$.1.2-,,,,1-3”,
City/State/ZIP:WA rie•,) CA q7z Z4- 0 Six or more residential units. oceonalloY•
0 Health-care faciiinen. , 0 Recreational vehicle parks.
Suite/bldg./Vt.#: 0 1 Project name: 0 Hazardous Jocadoos. 0 Supply voltage for more than
.4.„...„, • _ - 0 Service or feeder 600 amps or mote. 600 volts nominal.
Cross street/—.....uns to Job site: PEE SCREDULE
Description I Qty. I Each I Total 1 '
I New resides stogie-or multi-family dwelling unit
SubdiviSiOn: 1 Lot#: Includes attached garage.
1,000 sq.ft.or less _ 168.54 4
Tax map/parcel#:
Ea.add'I 500 sq.ft.or portion. 33.92 I
DESCRIPTION OF WORK Limited energy,residential
75.00 2
llra, pctsnp HOOli LA40 (with above sq.ft.)
Limited energy,mufti-family
75.00 2
residential(with above sq.ft.) ,
F., TENANT Renewable Energy 0 See Page 2
0 PROPERTY OWNER, 1 I-I Services or feeders installation.,alteration,antfor relocation
Name: (,)/I VI CL L.)4-n e-j1 C.1 200 amps or less ', 100.70 2
Address: 201 amps to 400 amps , 133.56 2
401 amps ro 600 amps 200.34 2
City/State/ZIP:
601 amps to 1,000 amps 301.04 2
f ,
Phone:( ) I
I Fax:( ) Over 1,000 amps or volts ,1 552.26 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 ampsi 168.54 2
0 APPLICANT 1 0 CONTACT PERSON AFfor Brancharants-.Ttnewuit; falteration,or extension,per panel
Business name:
above service or feeder fee, 7.42 2
each branch circuit
Contact name: 2
B.Fee for branch circuits without '
or feeder fee,first 1 56 1 8 14,I II
Address: branch circuit
City/State/ZIP: Pelt add'I branch circuit I 742 -7.41
Miscellaneous(service or feederinot included)
Phone:( ) Pax::( ) Each manufactured Or modular
67.84 f 2
dwelling,service and/or feeder
Email: Reconnect only $ 67.84 2
CONTRACTOR . Pump or irrigation circle 67.84 2
Business name: glyetiod )kin r 0.,e_ 7„,_, Sign or outline lighting 67.84
d
4
Signal eircuit(s)or limitedrterU 0 see pay 2 2
AddreSs:,510p, plu) a/ 4,4,6, , it k panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: are-51- 4-evte:454. 9—iiicp
...........,inspection(1 hr min) , 66-25/hr
/ .C,,,itip_w.r-7"
Phone:(0#)5 557_0.--L5D Fax:(,../r_42,0 /—Ite' Inve .stigation(1 lir min) 90.00/hr
re/
industrial plant(1 hr min) 78.181 lir
Email: 0 rnO(P15 0 OP/A:il. eor1;) , _ Inspections for which no fee is hr
CCB Lie.:t,760 a, Electrical Lie.:54-25g c.....Suprv.Lie.:i5-1 Fs specifically listed(%hr min)
T.
Suprv.Electrician signaturELECTRICAL , FEES /
e,required: m,.... ,".., . Subtotal:
Print nameK jijiver
,, t,,..,
a Date: Fd Zy/i 7 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): _7. 40
i
TOTAL PERMIT FEE: -71.z3
Authorized signature:
1 lids Permit ePplleatbm expires fin permit iS not obtained within 180
days after it has been wee-pied as conquer,.
Print name: Date:
I * Number of inspections allowed per Perron.
fNluadisgTerars\ELC PermftApp Ent_ERE doe Rev 06117/2015 440-46 int 11/05,1COMMEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14820 SW 109TH AVE, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Electrical ELC2017-00647
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor