Permit (205) CITY OF TIGARD ELECTRICAL PERMIT
Pri COMMUNITY DEVELOPMENT Permit#: ELC2018-00057
13125 SW Hall Blvd.,Ti Date Issued: 01/22/2018
Tt<a"1 and OR 97223 503.718.2439 9
Parcel: 2S 102CA00908
Jurisdiction: Tigard
Site address: 13440 SW ASH AVE
Project: STOCKBERGER Subdivision: VILLAGE GLENN Lot: 8
Project Description: (1)Branch circuit for bathroom exhaust fan.
Contractor: OWNER Owner: STOCKBERGER, SARAH
SARAH STOCKBERGER WETZEL, NATHAN
13440 SW ASH AVE 13440 SW ASH AVE
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 541-760-4318 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 01/22/2018 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/22/2018 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 enter. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You m- obt -copy of the ules or direct questions to OUNC by calling 503.23 :1987 r 1.800 332.2344.
Issued By: _ � /1
, Permittee Signature: / 4 --2
40
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 f„,. FOR OU FR_F. t ONFI
City of Tigard la?t.. v �' Received
Date/B : i Eli i )C� Permit#: „,
13125 SW Hall Blvd.,Tigard,OR 97223 t)�
i'1'6 Plan Review
g Phone: 503.718.2439 Fax: 503.598.1960 4,. �.`'' Related Permit#: t6f,: 'f(i 7- et t-36
Date/By: L tX
Inspection Line: 503.639.4175dy Date/By: Juris: H See Page 2 for
IIGARI) j.
Internet: www.tigard-or.gov 3 : + ,/ .otiftad/Method: Z'y Supplemental Information
t� t'?�*'v.<
TYPE OF WORK (Ai,� , ' � °� PLAN REVIEW
❑New construction Addition/alteration/reptPlease check all that apply pp y(submit 2 sets of plans w/items checked):
„1,.:.I' 0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building
Multi-family ❑Master builder ❑Other: less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations.
❑Fire pump.
buildings.
P P ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: i.3 r ❑Addition of new motor load of system.
. 1,:,, w i bv-, f es-' l o0HP or more. ❑«A„ «E» «1 2” "1 3»
City/State/ZIP: "� � 0 Six or more residential units. occupancy.
v `1 o m
o Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: r`l-L,R(,l` FEE SCHEDULE
Description I Qty, 1 Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
33 � 75.00 2
'( L t.�^ n j \,d o (with above sq.ft.)
Limited energy,multi-family
_ residential(with above sq.ft.) 75.00 2
PROPERTY O4'NERRenewable Energy ❑ See Page 2
0 TENANT Services or feeders installation,alteration,and/or relocation
Name:�R r G\V\ ?C'k pQ.a -4� 200 amps or less 100.70 2
Address: \S cI`'�D y 1.1 J1,\i 201 amps to 400 amps 133.56 2
Y P ) 401 amps to 600 amps 200.34 2
City/State/ZIP: 1 i 66,0^ 9),2a3 601 amps to 1,000 amps 301.04 2
Phone:(`3 1 ) 1 l p - Li 3 tl' Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
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 -.se,�-n a exchan l e according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
VD
Owner signature: j, / Date: V-1,71 p 401 amps to 599 amps 168.54 2
Branch circuits—new,alteration,or extension,per panel
0 APPLICANT ❑ CONTACT PERSON
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first
branch circuit ( 56.18 57,4 2
City/State/ZIP: Each add'l branch circuit 7.42 2
Phone: Miscellaneous(service or feeder not included)
( ) Fax: :( ) Each manufactured or modular
dwelling, 67.84 2
Email: service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy
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:( ) Fax:
( ) 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)
Suprv.Electrician signature, ELECTRICAL PERMIT FEES
required: t`
Subtotal: i 3
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 6.7w
Authorized signator ,M k `( - .-7.01.---) TOTAL PERMIT FEE: (,
Print risme: � This permit application expires if a permit is not obtained within 180
� n ,'\ 3\,�,:\),-\,ib � .,/ Date: 1-1 (;� D days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-46151(11/05/COM/wEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
�,
RESIDENTIAL WORK ONLY: ' FEE SCHEDULE
DescriptionQty. Each Total 1
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved: 5.01 to 15 kva 133.56 2
n 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
Fl Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
nOther: 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('h hr min)
EL C TICAL PERMIT FETES
COMM GAL WORK ONLY: %
�` `=� Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n L• andscape Irrigation Control*
❑ Medical
Fl N• urse Calls
n Outdoor Landscape Lighting*
❑ P• rotective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13440 SW ASH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Electrical ELC2018-00057
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor