Permit CITY OF TIGARD ELECTRICAL PERMIT
a 11. '• COMMUNITY DEVELOPMENT II
Permit#: ELC2017-00901
T(GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/06/2017
Parcel: 1 S 134AD02000
Jurisdiction: Tigard
Site address: 11367 SW LAKEWOOD CT
Project: AJ INVESTMENTS LLC Subdivision: ENGLEWOOD Lot: 60
Project Description: Reconnect only.
Contractor: Owner: AJ INVESTMENTS LLC
16933 SE FOSTER RD
GRESHAM, OR 97080
PHONE: PHONE: 503-998-0276
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 12/06/2017 $67.84
Specifics:
1 ea 12%State Surcharge- 12/06/2017 $8.14
Electrical
Type of Use: SF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
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 Cente. Those rul s are set forth in OAR
952-001-0010 through OAR 952-001-0090. Yo ... obtain s or direct questions to OUNC by calling 503.232.19 r 1.800.332.2.844.
Issued By: �'ilr�,irf _. _� ..' ee Signature: / 'U ��
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
City of Tigard Received r
Date/B : ..
* 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 ° ..0 Date/B : Related Permit#:
Email: TigardBuildingPermits@Tigard-or.gov . b O "'` ReadyDate/B
y: ® See Page 2for
Inspection Line: 503.639.4175 Int ti "or gov Notified/Method: MMIll Supplemental Information
TYPE OF WO !c p��� PLAN REVIEW
❑New construction ❑Addition/alteration/repl&event ...;.';;',... '";--;a.;",, Please check all that apply(submit 2 sets of plans w/items checked):
�`''11 +' 4 ❑Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition ❑Other: "'N 'tt
�6 �,,y� I-:
S where the available fault current 0 Marinas and boatyards.
CATEGORY OF.CQNSTRU 1 �`y� exceeds 10,000 amps at 150 volts or 0 Floating buildings.
ess to round,or exceeds 14,000 ❑Commercial-use❑Commercial/industries# Accessory building g
amps
lfor all other installations. agricultural
buildings.
1-and 2-family dwelling
❑Multi-family 0 Master builder ❑Other: 0 Fire pump.
❑Installation of]50 KVA or
JOB,SITE'INFORMATION AND LOCATION 0 Emergency system. larger separately derived
I� ��n, ���� ❑Addition of new motor load of system.
Job#: Job site address: i 1. 3 b) S� W,,,„c C,( 100HP or more. ❑"A","E","1-2",`°1-3",
City/State/ZIP: 1 / ❑Six or more residential units. occupancy.
I ��Y� ^ c L3 ❑Recreational vehicle parks.
0 Health-care facilities.
Suite/bldg./apt.#: Project name: /4f J ? s ��c, 0 Hazardous locations. 0 Supply voltage for more than
�✓✓ J emsJ ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total 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, WOR Limited energy,residential 75.00 2
A- (with above sq.ft.)
C-eitt i� �� / Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
PROPEI<LI' OWNER:;` ' r' ❑ 1TANT , Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name: A3 1 vve5, 1,_.L.C- 200 amps or less 100.70 2
Address: 16—tv--5 y--,_ �S•W,n•— a 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: G,re.,' 9 70f�0 601 amps to 1,000 amps 301.04 2
Phone:(S03) '10 —0 —7(. Over Over 1,000 amps or volts 552.26 2
Email: ,���h� Cr.} Temporary services or feeders installation,alteration,and/or
f;�t`�c bt n relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
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"'.AP,PLICANi'''. i
CONTACT PERSON 'es, Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: .rcaM:/ ai i 4 54A— above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first
Address: branch circuit 56.18 2
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Each manufactured or modular
dwelling,service and/or feeder
Email: 67.84 2
Reconnect only 1 67.84 C 7 2
" CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) 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)
:;ELECTRIC. PERMIT'FEES ,
Suprv.Electrician signature,required: Subtotal:
6 7,rii
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): f-/
Authorized signature: 112, ` 'v TOTAL PERMIT FEE: �. r
t This permit application expires if a permit is not obtained within 180
•
Print name: ,,1e,( ) Date: `2t(0 1 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR ERE.doc Rev 10/26/2017 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RES )DENTIAL WORK ONLY:' FE ,.§CHEDIULE
Description I Qty. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
ri Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
n Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
I-7 Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
n Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
COMMERCIAL ,
LE. : . SALi' RMxFEES,
WORKONLY 3. � r.
Fee for each commercial system: $75.00 per
l aubtotaEnteron Page 1):
3' * Number of inspections allowed pepermit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
I-1 Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELRERE.doc Rev 10/26/2017
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11367 SW LAKEWOOD CT, TIGARD, OR, 97223 December 7, 2017 at
1 :38:07 PM
Record Type: Record ID:
Residential - Electrical ELC2017-00901
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Re connect only, ok
Violation Summary:
Inspector Contractor