Permit Support Document (28) k CITY OF TIGARD a:,vm`kffleaELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2017-00822
r '1�2l���A Date Issued: 11/02/2017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.243' Parcel: 2S102BC05200
Jurisdiction: Tigard
Site address: 12515 SW PATHFINDER CT
Project: Ross Subdivision: YOLO ESTATES Lot: 1
Project Description: Kitchen remodel and demo old heaters.4 circuits. ,11/28/17:REPRINTED permit to include(2)branch circuits.
Contractor: BENTLEY ELECTRIC INC Owner: ROSS,JOSEPH&SUZANNE
41330 SW EDNA LANE 15362 NW WOODED WAY
GASTON, OR 97119 BEAVERTON, OR 97006
PHONE 503-789-4229
PHONE: 503-528-4443
FAX: 503-985-9595
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo/Purchase 11/29/2017 $93.28
Specifics:, Service or Feeder
1 ea 12%State Surcharge- 11/29/2017 $11.19
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $104.47
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 • R• .-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.
Gf
Issued By: '�A -9 -- Permittee Signature: w2. / /`- ' e'lf
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.
....... .mmlimmimmilmmummimmummimmiiimimimmilmimimmilimmummENI
Electrical Permit ApplicatioRECEIVED FOR OFFICE USE ONLY
City ofTigard
13125 SW HUH Blvd..Tigard,OR 97223
M
: 5ax: 598.1I"n
NU V 22 2017
4 f7"37,,,.... Permit tt: tr- i 7.....06 ??Q
Phone03.718.2439 F03.5
Plan Review
DatelBy Related Permit
_
Inspection Line: 503.639.4175 Reddy f)ate.,By: kul: 61 See Page Pm
1GARD w
4 Internet: ww.ti.gard-or.gov .
CITY OF TiGA RD NotifiediMethodP.
Supplemental Information
TYPEQy.at)li&,... PLAN REVIEW
0 New construction gAdditioltnnaG•DWISioN- Please check all that apply(submit 2 sets of plans wlitems checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other.
where the airailable fault current 0 Marinas and boatyArds.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
Xless to ground,or exceeds 14,000 0 Commercial-use agricultural 1.-and 2-family dwelling. 0 Commercial/industrial 0 Accessory building
amps(be all other installations, buildings
0 Millii-C910ily 0 Master builder 0 Other: 0 Iln e pump. 0 Installation or t,t,t)KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency SyStertllamer separately derived
,) ,i( fi., ,L,,, 0Addition of new motor load-)1. systern.
Job P. Job site address: („2.,5-15 .,--,1,,o it a I ilz, .., , ,00141,or more.
0 S ix or more residential units occupancy,
City/State/ZIP: (rac ini i rf q-7.„)..,2,..-.70 Health-iiiire facilit
3 0 Recreational vehp
icle inks
,) .." ( ies.
ipa. ,..
Suite/bldg/apt.#: Project name: 11 - • - r,C8'NI A ['Hazardous locations 0 Supply voltage for more than
k. -k: . i; -.._, '. 1.,,,. h, 0 SerAce or feeder 600 amps or more. 600 volts nominal.
otiorirtztims
Cross street/directions to job site: or. • 0.
FEE SCITEIYULE
Description I Qtr. I Each I l'otal. I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.II.or less 168.54 4
Tax map/parcel 4:
Ea.add'l 500 sq.ft.or portion 33.92
DESCRIPTION OF WORK Limited encase,residential
75.00
icid.' fr.)- exi'.sivi - urrYiLf t--,7 I-6, • Lim(with above sq.It.)
t t ited energy,multi-family
4.9\
ft ' .
(.2 .5
residential with above sq.It)
,...,.. Renewable Enemy 75.00
0 See P re 2 I
0 PROPERTY OWNER U TENANT • •
_ TENANT Sec Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 2.00.34 2
Cil!,:iSttile[Z.1P.
601 amps to 1.000 amps 301.04 2
Phone:( ) Fax:( ) Over 1.000 amps or volts I 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This-Instal 'abort is being made on property that I own which is not 200 amp%or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447, 19,670.and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 maps to 599 atnps 168.54 2
Branch circuits—new,alteration,or extension,per panel
0 APPLICA:NT o CONTACT PERSON A.Fee for branch circuits with,
11 t Isi nests name: above service or feeder fee.
7.42 ,
each branch circuit .
Contact name: B.tee for branch circuits without
service or feeder fee,fast
Address:
branch Circuit 56.18 2
City/State/ZIP: Each addl Malta circuit 4" 7.42 el,f al 2
Miscellaneous(service or feeder not included)
Phone:i ) Fax: :( ) Each manufactured or modular
67.84 /
dwelling,service andlor feeder
Email:
Reconnect only 67.84
CONTR ACTOR Pump or Migation circle 67.84 2
Business name: ' kr..--') 'edt,„ El - , te.,..,
. —ft, i--- -'' fr Sign or outline lighting 107.84 2
Address: 41 3 5 0 03 .- ' itiCk 1,„(2...,
i t — .----a, Signal cireuiths)or lint ited-energy ,..-,
panel,alteration,or extension. ' ' See Page 2 2
t• Each additional inspection over allowable in any of the above
City/State/ZIP: a ,,,,,,• tx 7 1 1 61
..., 4. Additional inspection fl hr min) 66.25!hr
Phone:(r.. 3l 7f_7 . A At
j Fax:t ) investigation(1 he min) 90.00(hr
is 1 . s, Industrial plant(1 hr min) 78.18.,hr
I .
illittni.:.104&n ertf.eileicfr,ii,_III Ki,4(oryl
Inspections for which no fee is
,,, ,,,_ . 90.00i lir
(2(21.1 Lic: itz,,,..,( r.' e
Liectricai l/rc.;f2,..--- - !',z, ouprv.lie:SO"i3 speed wally listed(Vt hr min)
''T-,
ELECTRICAL PERMIT FEES
, , ,,
Suprv.Electrician signature,requir / bar„. 3,--1,,,,,, Subtotal: /11,1311
Print name: ital,tak
,,,i. Date: „t ,
0 Plan Reviow Required(25%of permit fee):
LA-Tmai) - a ...„, 0/C. '
J _ Stale surcharge(12%of permit fee):
A t ithorized signature: TOTAL PERMIT F,E:
This permit application expires if a permit is; obtained within I
Print name: I Date: days after it has been accepted as comp c .
. Number of aspect allowed per permit.
hi.l,eildihi6Penntsd:227 PettnitAppI.I.kERT-ldes Rev ikilrill615 440-4515'M 1b5 CQMINI.13
CITY OF TIGARDII
ELECTRICAL RESTRICTED ENERGY PERMIT
: I ' COMMUNITY DEVELOPMENT Permit#: ELC2017-00822
t 4 ', Date Issued: 11/02/2017
T f G A is D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.24 ' '''‘10
,, I 00/
Parcel: 2S102BC05200
Jurisdiction: Tigard
Site address: 12515 SW PATHFINDER CT
Project: Ross Subdivision: YOLO ESTATES Lot: 1
Project Description: Kitchen remodel and demo old heaters.4 circuits. 11/28/17:REPRINTED permit to include(2)branch circuits.
6/20/2018: REPRINT to add(1)branch circuit for basement bedroom heater.
Contractor: BENTLEY ELECTRIC INC Owner: ROSS,JOSEPH&SUZANNE
41330 SW EDNA LANE 15362 NW WOODED WAY
GASTON, OR 97119 BEAVERTON, OR 97006
PHONE: 503-789-4229 PHONE: 503-528-4443
FAX: 503-985-9595
FEES
Description Date Amount
Specifics: Branch Circuits wo/Purchase Service or 11/29/2017 $93.28
Feeder
12%State Surcharge-Electrical 11/29/2017 $11.19
Type of Use: SF Branch Circuits w/Purchase Service or 06/26/2018 $7.42
Class of Work: ALT Feeder
Total Number of Systems: 12%State Surcharge-Electrical 06/26/2018 $0.89
Audio&Stereo: N
Security Alarm: N
Garage Door Opener: N
HVAC: N
Vacuum System: N
Other: N
Other Desc: 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 OAR 95 - 01-0090. You ,,:y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _ •,--2' . 1 Permittee Signature: .e/`G6Gi liZ
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.
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12515 SW PATHFINDER CT, TIGARD,
OR, 97223
Record Type: Record ID:
Residential - Electrical ELC2017-00822
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor