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Permit (105) CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit*: ELC2017-00815 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/01/2017 Parcel: 2S 102AB00914 Jurisdiction: Tigard Site address: 12105 SW 92ND AVE Project: Hamnes Subdivision: KIMBERLY ADDITION Lot: 14 Project Description: Replace(1) 100 amp panel Contractor: PATTERSON ELECTRIC LLC Owner: HAMNES, ROBERT J MARILEE 1834 NE ESTATE DR 12105 SW 92ND AVE HILLSBORO, OR 97124 TIGARD, OR 97223 PHONE: 503-703-1241 PHONE: FAX: FEES Quantity Description Date Amount Specifics: 1 ea Services or Feeders-200 11/01/2017 $100.70 amps or less 1 ea 12%State Surcharge- 11/01/2017 $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: 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 O 95 -104-0090. ou may obtain a copy of the rules or direct questions to OUNC by callin•503.232.1987 or 1.800. 2.2344. Issued By: v G Permittee Signature: \r-L �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. Electrical Permit Application Q a - t. ,r �v.� City of Tigard eceived f 71 13125 SW Hall Blvd.,Tigard,OR 97223 DateBy: /1 `� Permit No C ` 7 Ql/,/� Phone: 503.718.2439 Fax: 503.598.1960 lt�0' 1 7 Q 1 f PlanReview C/ Date/By: Other Permit: TIG �R l� Inspection Line: 503.639.4175 Internet: www.ti ard-or. ov ., Date Ready/ed/Met y: Juris: S See Page 2 for g g Lit I T (. r E(7 titt"i;)Notified/Method: �f�L�II'�� DIVISION I Supplemental Information TYPE OF Wt RK !t V PLAN REVIEW 9 New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below): 0 Demolition 0 Service or feeder 400 amps or more El Building over three stories. 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. ice! 1-arid 2-famllless to ground,or exceeds 14,000 0 Commercial-use agricultural y dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings. ❑Multi-family 9 Master builder 0 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.: I Job site address: 12 j(:)5 3,Y X N n 100HP or more. occupancy. 4� Ave--, 0 Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP: �I ct r C` 0/ 7�� ❑Health-care facilities. 0 Supply voltage for more than / ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: I Project name: F ct r,;j :,,1 ,e 5 0 Service or feeder 600 amps or more. t �r y Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Fee. I Total New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: I Lot no.: 1,000 sq.ft.or less 168.54 4 Tax map/parcel no.: Ea.add'l 500 sq.ft.or portion 33.92 1 Limited energy,residential DESCRIPTION OF WORK (with above sq.ft.) 75.00 2 ` Limited energy,multi-family R., _p _c,.c . Lc.; 1,C 0 A , ct. o. 'c...L (, t ,q residential(with above sq.ft.) 75.00 2 4 j� \ Services or feeders installation,alteration,and/or relocation \.Q- \ 03 1\ t \C�l 1 1, \,A)r t CA. � f�" \, ,(_' 200 amps or less 100.70 i 3O ,7tZ,,,2 ❑ 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:( ) I Fax:( ) 200 amps or less 59.36 1 Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2 Owner signature: Branch circuits—new,alteration,or extension,per panel Date: A.Fee for branch circuits with 0 APPLICANT I X CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: B.Fee for branch circuits without ( service or feeder fee,first Contact name: ' !c,Q 117 G, . CSC branch circuit 56.18 2 Address: „\ Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Ctty/State/ZIP: Each manufactured or modular dwelling,service and/or feeder 67.84 2 Phone:(5 03) 703 _ 1. t„1l 1 I Fax: :( ) Reconnect only 67.84 2 E-mail: Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Business name: Pc.. . rS Le (A, , L-1 C._ panel,alteration,or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: It 39 N (,' Additional inspection(1 hr min 1,::: 1 ,, [ , P ) 66.25/hr City/State/ZIP: (4 LL' ` Investigation(1 hr min) 66.25/hr / 7 1 t Industrial plant(1 hr min) 78.18/hr Phone: L' Fax: (w3) 703 — ( 2 Lr I ( ) Inspections for which no fee is .( t — specifically listed(%2 hr min) CCB Lic.: 90.00/hr Electrical Lic.: 0-7 70I Suprv.Lic.: /76 ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: '�� - —{ \� Subtotal: OO ,7 , v"tiLv'` �f / si\. Plan review(25%of permit fee): Print name: d o`�e ti � E%�'�°"��.�o tA f / i',.2.I Date: � � _ � 7 State surcharge(12%ofpermit fee): t O Authorized signature: TOTAL PERMIT FEE: /,oz , 7J This permit application expires if a permit is not obtained within 180 Print name: I Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC-PermitApp.doc 07/01/10 440-4615T(]1/05/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* O Heating,Ventilation and Air Conditioning System* O Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918-309-0000) Check Type of Work Involved: O Audio and Stereo Systems O Boiler Controls ❑ Clock Systems O Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC O Instrumentation ❑ Intercom and Paging Systems O Landscape Irrigation Control* ❑ Medical O Nurse Calls ❑ Outdoor Landscape Lighting* O 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: 12105 SW 92ND AVE, TIGARD, OR, 97223 Record Type: Record ID: Residential - Electrical ELC2017-00815 Inspection Type: Inspector: 199 Electrical final Jeff Grove Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor