Permit (101) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2018-00351
TLGARL) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/29/2018
Parcel: 2S 111 CA03500
Jurisdiction: Tigard
Site address: 9695 SW LAKESIDE DR
Project: FLAXMAN Subdivision: SUMMERFIELD NO.12 Lot: 655
Project Description: Panel replacement.
Contractor: MATES ELECTRIC Owner: FLAXMAN, JANE TR
11124 NE HALSEY RACKI, JOAN REVOCABLE TRUST
PORTLAND, OR 97220 FLAXMAN, BRUCE
9695 SW LAKESIDE DR
TIGARD, OR 97224
PHONE: 503-516-4142 PHONE:
FAX: 503-695-6263
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 05/29/2018 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 05/29/2018 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
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 ru-s are set forth in OAR
952-001-0010 through OAR 952-001-0090. You tain a c'•y of the ru- or direct questions to OUNC by calling 503. 32.1987 or 1.800.332,P44.
Issued By:-_ a. Permittee Signature:
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 ApplicatiRECEIvEn ut)R omit': I S1: 011.1
City of Tigard Received _ '
.11111
n 13125 SW Hall Blvd.,Tigard,OR 97223 Date/B : f." �>
Phone: 503.718.2439 Fax: 503.598.1 Plan Review
y 2 9 2018 Date/B : Related Permit#:
Inspection Line: 503.639.4175 ReadyDate/By: H See Page 2 for
T I G A!L I�
IBM
Internet: www.tigard-or.gov Notified Method: Supplemental Information
TYPE OF OF TIGAki
i
❑New construction dltiOn/a�rT �IsiUI 1�) PLAN REVIEW
Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
ID Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or
0 Floating buildings.
ag_kand 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
0 amps for all other installations. buildings.
Multi-family ❑Master builder 0 Other: 0 Fire pump.
0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: Q/ Q+� t. / _/ ( ❑Addition of new motor load of system.
r 6 C ✓ S"t/ L `z CST e lir 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: 77 ez i-e_4 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: )1)NE .4.k ,A- / 0 Hazardous locations. 0 Supply voltage for more than
/� ❑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.
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
r Limited energy,residential
ger (
te_ ce -k_ ejJ k i4 1 ` pie Al�� (with above sq.ft.) 75.00 2
Limited energy,multi-family
Pfr G!f}=/c_ 1''4171/..e-2-- GC/C 4 CS residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
0 PROPERTY OWNER 0 TENANT
Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 1 100.70LAG.,,tS ?eJ 2
Address: 201 amps to 400 amps 133.56 2
City/State/ZIP:
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) 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,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
APPLICANT CONTACT PERSON Branch circuits-new,alteration,or extension,eer panel
A.Fee for branch circuits with
Business name: /V( e-1. le . p (e-G I�^C.._.-s !t� C- above service or feeder fee,
/ each branch circuit 7.42 2
Contact name: 6 �'U /0/51---i--&-- ', B.Fee for branch circuits without
O� service or feeder fee,first
Address: /1 Zit ^/' Cx S e_c_., n4 6 6 ? ` branch circuit 56.18 2
City/State/ZIP: PO •_i/„‘I--A,A ✓/ ,� q 72 2_ Each add'l branch circuit 7.42 2
Phone: /� / ` /L ! Miscellaneous(service or feeder not included)
(' ) � I v, L. - I "c 2i • Fax::( ) Each manufactured or modular
Email: / dwelling,service and/or feeder 67.84 2
d q tit / M 6) e.$ e!e_'-bri G' - (_,e) Al Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: P'/4 T� 5 �_ t , /f/ C— Sign or outline lighting 67.84 2
Address: 1 f I Z �/� / Q 6 7 Signal circuit(s)or limited-energy
dC` S l b"04 panel,alteration,or extension. 0 See Page 2 2
e.� of`-7 L Z Each additional inspection over allowable in any of the above
City/State/ZIP: 'pe,121 -7v 5
�l Additional inspection(1 hr min) 66.25/hr
(�� ) cl
Phone: 5/6 ,?"4
e'Z Fax:(513 ) �r 6 Z�j '-72Investigation(1 hr min) 90.00/hr
Email: Ciao (0 0 , 1�G t�I.G c_O Industrial plant(1 hr min) 78.18/hr
p Inspections for which no fee is
CCB Lic.j)/ 1, 7/ Electrical Lic.:` -g286. Suprv.Lic.: 3 912 $. specifically listed('V hr min) 90.00/hr
Electrician ELECTRICAL PERMIT FEES
Suprv. signature,required: (i _
Print name: �N M! - Subtotal: /D, 70
l/ A.,---------
te: 2--at - /0 ❑Plan Review Required(25%of permit fee): ._
E / Le
State su charge(12%of permit fee): ,a 5-
Authorized signature: - TOTAL PERMIT FEE: (/2 7 Y
This permit application expires if a permit is not obtained within 180
Print name: /J�-� yl,.,q-ra Date: j Z_q f—(d days atter it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
_ , FEE SCHEDULE
RESIDENTIAL'WORK ONLY S 1 Each Total'. .. . �' - Description I Qty.
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
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ B• urglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ G• arage 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
>100 kva-no additional charge 0.0 3
❑ Vacuum Systems*
Each additional inspection over allowable in any of the above:
riEach additional inspection is 66.25/hr 1
O• ther: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(/hr
mm)
ELECTRICAL
EPE R f F
S' a
' 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
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
111 HVAC
❑ Instrumentation
El Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitAppELR_ERE.doc Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9695 SW LAKESIDE DR, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Electrical ELC2018-00351
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor