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Permit Support Document (45) CITY OF TIGARD 1117 hr ‘ ELECTRICAL PERMIT 111 COMMUNITY DEVELOPMENT AYy �, Permit#: ELC2017-00758 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 /V /1 / r Date Issued: 10/11/2017 Parcel: 2S 104CD05400 Jurisdiction: Tigard Site address: 13975 SW BENCHVIEW TER Project: Jost Subdivision: HILLSHIRE ESTATES Lot: 54 Project Description: 60 amp sub panel. 2/14/2018: REPRINT permit to add(6)branch circuits. Contractor: MISTER SPARKY OF BEAVERTON Owner: JOST,ANDREW M&MINH THU LY 6775 SW 111TH AVE STE 20 13975 SW BENCHVIEW TER BEAVERTON, OR 97008 TIGARD, OR 97223 PHONE: 503-643-3500 PHONE: 541-554-6887 FAX: 503-861-2157 FEES Quantity Description Date Amount Specifics: 1 ea Services or Feeders-200 10/11/2017 $100.70 amps or less 2 crt Branch Circuits w/Purchase 10/11/2017 $14.84 Type of Use: SF Service or Feeder Class of Work: ADD 1 ea 12%State Surcharge- 10/11/2017 $13.86 Electrical Type of Const: 6 crt Branch Circuits w/Purchase 02/14/2018 $44.52 Occupancy Grp: Service or Feeder 0 ea 12%State Surcharge- 02/14/2018 $5.35 Electrical Total $179.27 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR• .: a 190. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: 7/ / 1 J� Permittee Signature: 6147 17"'/°4/(' fl /\./ OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Antplicatf CEt FOR . Nl [ l .9' City of Tigard 1 20�$ Received f)atz/By. Felon q 1111 . 13125 SW Hall Blvd., Tigard,OR 97223�� jF � �� �� �� c f �_` Phone. 503 718 2439 Pax: 503 PIat1 Review � - ��� � L�atel®}: " Related Penna N 'CICs Rt? Inspection l.ine: 503 639 4175 Ready/)ate/Its: Mira ® See Page 2 for Internet: www tigard-or gov BUILDING DIVISION NMitiedMethod E Supplemental Information i TYPE OF WORK FLAN ItEVIE41 New construction 0 Addition/alteration/replacement r Please check all that apply(submit 2 sets of plans w/items checked). Q Service or feeder 400 amps or more ❑Building over three stories ❑Demolition ❑Other: 1 whew the available fault cunent ❑'Marinas and boatyards iCATEGORY OF CONSTRUCTION ION 1 exceeds 10.000 amps at 150 volts or Q.Floating buildings and 2-family dwelling 0 Commercial/industrial ❑Accessory building� 1 less to ground_or exceeds 14,000 0 Commercial-use agricultuisl amps for all other installations. buildings 0 Multi-family 0 Master builder Other: ISO❑ i 0 Fuc pump. 0 Installation of I_ KVA at �. JOB SITE INFORMATION AND LOCATION ❑Gnergency system laigei separately derived Job#: Job site address: ❑Addition of new motor load of system A. ^ r IOOtiP or mote City/State/ZIP: -i--1 `,rj7 r nSis of mote residential units. occupant}.. G-�'-3 ,._a.,�„ ,�„u„ 3 ❑Health-tate facilities0 Recreational vehicle pat s Suite/bldg./apt.#: Project name: ( 0 Hazardous locations Q Supply voltage fat more than E0 Ser vice of feeder 600 amps or more 600 volts nominal Gross street/directions to job site: {- FEESCIIFDUI,F . netx qtl wr 1 t?is I aetr 1 Trrtat . New residential single-or multi-family dwelling unit, Subdivision: Lot#: Includes attached garage. 1.000 sq f1 or less i6 54 X Tax map/parcel#: Ea add'I 500 sq_ft or portion m e12 ) DESCRIPTION OF WORK t ranted en rev,residential 7 + e61t �. ...L.._ 4? I Iss li JE0,sr} at,," —VALN44 -Gicr .r,IffLC-44E ''" 00 1 Limited energy,multi-family residential fwith above set Ii) 75'x30 Renewable E_nt.ryt 0 See P4162 i I. (] PROP1 R 1 Y'.OWNER 0 TENANT N.ANT l ervtces or feeders installation,alteration,undfor re Ito'thou 1. Address: ; € 201 amps to 400 amps 4 1 ,,f I s 1401 amps to 600 amps 1 ?10<,4 2 City/State/ZIP: 1601 amps to 1,000 ami i =('tl 2 . Phone:( 4 A5 Fax: Over 1,000 amps or volts c_'26 t ( : Temporary services or feeders installation,alteration,and/or Email: relocation Owner installatioThis installation is being made on property that I own which is not 200 amps or less ?6 36 1 n: t I intended for sale,lease,rent.or exchange.according to ORS 447,449.670.and 701. 201 amps to 400 itur 13°08 2 Owner signature: Dale: 401 amps to 599 amps 1 168 54 Branch cit cults new,alteration or extension, r panel © API'1.[GAM1"I ❑ 0011"1':107' PERSON' - 1� A Fee for branch circuits with Business name: above service or feeder fee, m.....,.m.�.... .. ...�. .,-„,..4,.».�.._. each hri.ochSaiv.ou( .. A z Contact name: rorb 1 t# Fee 1'or branch circuits with/ r service or feeder fee,first , Address: I s6 branch circuit .� ..�.....u.. -�,..,.....m....,...e.. .�.... _.may ... City/State/ZIP Each add'I branch circuit ( 742 'ie1.2. v ._._.._. 4itscellancous(vera is or feeder nett Pia lad rd 1 Phone:( ) Fax..( ) Ea,:h.mainifitekirvki Or tromislir --I— _ "-LS/4:4”; . - t 68" "`--H dwelling,service and/or feeder iEmailfl/CU� • _1GAA(1.410/7 h ��7 . ! 7 � f w : ' 187 84 . 2 i CONTRACCOR shit ....a.:. ,,., a( 3 kI?@F};or lint kt alba/Galzb tk, rS r�#,4 Business name; :,4h rt or outline lighting C r,7,a4 -- K-1.-1 er t � * � 6 .'"._.'_.."'"`. ,gnat c(rcuit(s)or limited energy ...w_ ' Address:(--i r j• ai —2-'2— --c, „panel.aitarauon,or extension Cl see Page 2 p 1 L ( j C1)'Stitte/I,IP;' t 1 ttchaddltaontfinspectinaoverallowableintnyoftheabove I clad e- _.0- -. _ �_ �.m i -...__ ;tda naltn.�x,,,tint(1 hrmin} 6f, g hr I (hone: ) ) -2 5.60 Fax: , rills#t3 hr I I ` ( ) Imeehkahon(Ihrmin) Email: Industrial plant(I hr min) i 7818:hr Hi - . , - . . Inspections for which no fee is ° CCB Lie.:: Electrical tic.: 1t e, S.tpry I ic.: ,', listed „ x tr`i Thr 1 vlfrcally list d t'.hr min} ... ..�Gcl ._ - _ . ( @I,ECTRICAL }'FRMLI FITS Suprv.Electrician signature.required: t fvL I = _ "�� ►� - v `' oi ;,> Print name:ikk„,4pate 0 Plan Reew Required(25%of permit fee' { ` � `' f_m ! . t lStatesurchar e I2%of permit fee): Authorized signature: TOTAL PERMIT FEE I.,'` t I ""'”' "'"”" •-•-^-'^d- -^^^^ - This permit application expires it a permit is not obtaine within 151) Print name: Date: days after it has been accepted as complete. ^- -... _..,,... --.a ' Number of inspections allowed pet pelmil. (,,/5 I`aurid ir:egerm tdh'LC PermiIApp_ELR_ERt.doe Ru /I 5, 7nD1 t 4-5)-.4615T(1 i n51COJ11 Ea 1 %e City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13975 SW BENCHVIEW TER, TIGARD, OR, 97223 Record Type: Record ID: Residential - Electrical ELC2017-00758 Inspection Type: Inspector: 199 Electrical final Jeff Grove Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor