Permit ELECTRICAL PERMIT
ELC2018-00132
y CITY OF TIGARD
Per
COMMUNITY DEVELOPMENT Date Issued: 02/26/2018
T t GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 526/201 2000
Jurisdiction: Tigard
Site address: 9590 SW ANNA BELLE CT
Project: SAGE BUILT HOMES Subdivision: ASH CREEK VILLAGE Lot: 6
Project Description: Temporary service for a job trailer.
Contractor: ROSS ELECTRIC INC Owner: SAGE BUILT HOMES LLC
2870 SE 75TH AVE#203 1815 NW 169TH PL STE 1040
HILLSBORO, OR 97123 BEAVERTON, OR 97006
PHONE:
PHONE: 503-642-2800
FAX: 503-642-5815
FEES
Quantity Description Date Amount
1 ea Temp Services or Feeders- 02/26/2018 $59.36
Specifics: 200 amps or less
1 ea 12%State Surcharge- 02/26/2018 $7.12
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $66.48
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 rules addpteby the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through 0 52-001-0090. You ma a y of the rules or dir- t questions to OUNC by calling 503.232.1987 or 1.800. .2344.
Issued By: -.....0.--- a • ee Signature: r—�I
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.
Ciamizzionifimm
Electrical Permit Application „ E
City of Tigard 11,0 zQ1g Receive:t Permit#: -LG;6t w 134
�^ e
13125 SW Hall Blvd.,Tigard,OR 97223 FEB- Plan Review
8 Phone: 503,718.2439 Fax: 503.598.1960 -�^� ' l\ Q 3ate/Bv: Related Permit/i.
Inspection Line: 503.639.4175 j�l r O 1 ` Date/By: r""z• HI See Page 2 for
I It, \::l) Internet: www.tigard-or.gov i�t1 t"9� �M1%2l 1OL led/Method: Supplemental Information
TYPE OF 'OMC 1i }l ( FLAN REVIEW_. 1
®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings,
less to ground,or exceeds 14,000 0 Commercial-use agricultural
_ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations buildings.
0 Multi-family 0 Master builder -y'0\
Other:sl( \ef ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 9590 SW Anna Belle Ct 100HP or more, ❑"A","E","1-2";"t-3",
0 Six or more residential units, occupancy.
City/State/ZIP:Tigard Oregon ❑Health-care facilities, Cl Recreational vehicle parks,
0 Hazardous locations 0 Supply voltage for more than
Suite bldg./apt.#: Project name:Ash Creek
ElService or feeder 600 amps or more. 600 volts nominal.
-
Cross street/directions to job site: FEE SCHEDULE
Description I Qh- I Kath I Tete] I *
New residential single-or multi-family dwelling unit.
Subdivision:Ash Creek Lot#: 6Includes attached garage.
_1,000 sqft or less 168.54 4
Tax map/parcel 4: Ea,add't 500 sq,ft.or portion 33,92r 1
DESCRIPTION OF WORK -Limited energy,residential 75 00 2
New Residential Construction - (with above sq.ft.)
Limited energy,multi-family 7500 2
residential(with above sq.ft,)
;" PROPERTY OWNER 0 TENANT _Renewable Enery 0 See Papp 2,
L-Services or feeders installationtalteration,and/or relocation
Name:Sage Built Homes LLC 200 amps or less 100 70 ._ 2
201 amps to 400 amps 133.56 2
Address: 1815 nw 169TH Place Suite 1040
-401 amps to 600 amps 200.342
City/State/ZIP:Beaverton Oregon 97006 601 amps to 1,000 amps 301.04^ 2
y
Phone:(971)221-4597 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less X 59.36 S9)(41 1
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
APPLICANT ❑ CONTACT PERSON _Branch circuits-new,alteration,or extension,per panel
® A.Fee for branch circuits with
Business name:Same As Above above service or feeder fee, 7.42 2
each branch circuit
Contact name:Alex Rodriguez TB.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: _ branch circuit
City/State/ZIP: Each add'1 branch circuit 7.42_ 2
Miscellaneous(service or feeder not included)
Phone:(971)336-6911 Fax: :( ) Each manufactured or modular 67 84 2
dwelling,service and/or feeder
Email:Planning@sagebuilthomesllc.com ^Reconnectonly 67,84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Ross Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address:2870 SE 75th Ave 203 panel,alteration,or extension.
Each additional inspection over allowable in any of the above_
City/State/ZIP:Hillsboro Oregon 97123 Additional inspection(1 hr min) 66.25/hr
Phone:(503)642-2800 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: ,
Inspections for which no fee is
90.00/hr
CCB Lie.: 157891 Electrical Lie.: 34-436C t Suprv.Lic.:y1315 specifically listedi/z hr mini 4
ELECTRICAL.PERMIT FEES
Suprv.Electrician signature,required: ./ -' Subtotal: 5-4- J
Print name: Stephen Ross 5 C r c,, 2o5t Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
z4 • - — TOTAL PERMIT FEE: in 18
Authorized signature: .l'Q l�uG
This permit application expires R a permit is not obtal within 180
Print name: Alex Rodriguez Date: 2/1/2018 days after it has been accepted as complete.
• Number of inspections allowed per permit.
t\Building\Permits\ELC_PeimitApp_ELR_ERE doe Rev 06/17/2015 440-461 iT(11i05/COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9590 SW ANNA BELLE CT, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Electrical ELC2018-00132
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor