Permit (185) CITY OF TIGARD ELECTRICAL PERMIT
11COMMUNITY DEVELOPMENT
Permit#: ELC2018-00434
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/27/2018
'TIGARD Parcel: 2S114BB21500
Jurisdiction: Tigard
Site address: 16546 SW 103RD AVE
Project: JETT Subdivision: RIVERVIEW ESTATES NO.2 Lot: 59
Project Description: (2)branch circuits for electric vehicle charging station.
Contractor: OWNER Owner: BRADLEY&NICHOLE JETT
BRADELY& NICHOLE JETT 16546 SW 103RD AVE
TIGARD, OR 97224 TIGARD, OR 97224
PHONE: 503-352-5002
PHONE: 503-352-5002
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 06/27/2018 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 06/27/2018 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 issu-nce, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifijcc� on Center. Those rules are t'forth in OAR
952-001-0010 through OAR 952-001-0090. You m- •- _ •.y of .- - or direct questions to OUNC by callina'503 '2.19;7— 1.8r+.332.23 .
Issued By: 4111111;�� . Permittee Signature: 11
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 A lication
pp R � FOR OFFICE USE ONLY
E„City of Tigard Received
- MI
't 13125 SW Hall Blvd.,Tigard,OR 97223 DateB : i if� �;
Plan Review
• Phone: 503.718.2439 Fax: 503.598.1960III
.j U N 2 A
r} 4,u ate/ : Related Permit#:
Inspection Line: 503.639.4175 R-.. Date/By: 0 See Page 2 for
TIGARD Internet: www.tigard-or.gov 3-s ()Flit;
tJit I,„10. . d/Method: Supplemental Information
rf�, / /Z/� ��� �� �� : ;BiS.:47,%'AlZi *.:NA e%�;i` , fI % A /
/
❑New construction E Addition/alteration/r;:;''Ply -• ' v Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other: 0 Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current
'f Marinas and boatyards.f � � - :)�,- � / �% , � , . Ff /lu veyi
exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-famil less to ground,or exceeds 14,000 0 Commercial-use agricultural
y dwelhri g ❑Commercial/industrial ❑Accessory building
amps for all other installations. buildings.
❑Multi family ❑Master builder ❑Other: 0 Fireuin
p p. 0 Installation of 150 KVA or
'47zzzgar2 /i/ ® r,,t,.sf,c„F,.. j',3tioroa% sts, 0 Emergencysystem' larger separately derived
Job#: Job site address: 16546 SW 103RD AVE ❑Addition of new motor load of system.
]OOHP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:97224 ❑Six or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:EV STATION 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:SW RIVERWOOD DR erf // / ;,,,,„/ 4144,
, /,, ,
Description I/Qty. Each Total I *
New residential single-or multi-family dwelling unit.
Subdivision:RIVERWOOD ESTATES I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:2S114BB21500
f, r if r rf f, a :fy r Ea.add']500 sq.ft.or portion 33.92 1
�/ !! /' KMIEO'” ,,,,. ,,*1*' .,,...: lal f 1 frl/ ,,% Limited energy,residential
INSTALLATION OF EV LEVEL II CHARGING STATION (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
' �'�i ff/f Renewable Energy 0 See Page 2�� ��" '"rt " � � / `�� r �E :WIf� Services or feeders installation,alteration,
and/or relocation
Name:BRADLEY&NICHOLE JETT 200 amps or less 100.70 2
Address: 16546 SW 103RD AVE 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:TIGARD/OR/97224 601 amps to 1,000 amps 301.04 2
Phone:(503)352-5002 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installatio • '-,installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sa-, ea rent,o s u•e,according to ORS 447,449,6 0,and 701. 201 amps to 400 amps 125.08 2
Owner
r signature: AMUR Date 401 amps to 599 amps 168.54 2
,. r ,,` ,F7/2 V,�j",',/ , ,r ,/'/, / r, , r s ,Per panel
®� � v��f f/rel Branch circuits—new alteration or extension
�,/. .aF, �,../..0 rf..�. ,r- ,,.,.v. A O f ,. .:% f,,,,;..-, .,,,s.•} � /,- A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name:BRAD JETT B.Fee for branch circuits without
Address: 16546 SW 103"AVE service or feeder fee,first i 56.18 2
branch circuit •K
City/State/ZIP:TIGARD/OR/97224 Each add']branch circuit i 7.42 ii)-- 2
Miscellaneous(service or feeder not included)
Phone:(503)352-5002 Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:BLINKJETT@GMAIL.COM
s i -`r r «/r F e �r , Reconnect only 67.84 2
%/,s�; , J olr,`,`e/1;`'%,///'/'J'1`�F/f O,o t.. ''' 'i',a'%' ' /'//'`A",��//,f'`f"' O WOW
�/i,
/ -E- '. d 'ff. - %:/,1 1 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. ❑ 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(A hr mm)
ISINIJF/ A
Suprv.Electrician signature,required: Subtotal �py j� /
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): -7,63
Authorized signature: TOTAL PERMIT FEE: 7
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELRERE.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:
,+� !F ../ f ��J' �,Ji!s' ,f"�1i'F%'�,,JJJ,r `'�'�f�, ��,;/������������ F.`���:M R ®:�d '�'�J�r�•����'�
J> Total' i,.
D b ® J�J�f'`�``/ '�',f.``� �',�✓ JJAi/ �1�''��.� ///�' JJ r,,
a; aff
Fee for all residential systems combined: $75.00 DescriptionwaI em � Each Total
3 Renewable electrical energy systems:
Check Type of Work Involved: s kva or less 100 70 2
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:
❑ 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 552.26 2
with OAR 918-309-0040)
n 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
so-cificall listed 'A hr min
/F`�.r",'/�.•/,%'f ` Y. J** J�. fE"ff,r'%y/� '
%fi/,�r,;'��'fi s�.����.,f.,�. � „.,.�� . ,,,//ri�irrl%/�'!��f'f' ;'
1):
Fee for each commercial system: $75.00 Subtotal(Enter on Page
y * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ 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_PermitAppELRERE.doc Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16546 SW 103RD AVE, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Electrical ELC2018-00434
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor