Permit (208) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' • COMMUNITY DEVELOPMENT Permit#: ELC2018-00436
Date Issued: 07/03/2018
TI C�AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135BD02000
Jurisdiction: Tigard
Site address: 9590 SW ANNA BELLE CT
Project: Ash Creek Village,Lot 6 Subdivision: ASH CREEK VILLAGE Lot: 6
Project Description: (1)branch circuit for NC.
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: 503-642-2800 PHONE: 971-221-4597
FAX: 503-642-5815
FEES
Description Date Amount
Specifics: Branch Circuits wo/Purchase Service or 06/27/2018 $56.18
Feeder
12%State Surcharge-Electrical 06/27/2018 $6.74
Type of Use: SF
Class of Work: ALT
Total Number of Systems:
Audio&Stereo: N
Security Alarm: N
Garage Door Opener: N
HVAC: N
Vacuum System: N
Other: N
Other Desc: 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 Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19879or 1.800.332.2344.
41 Issued By: '/^ Permittee Signature: /J� (. /2/L!�
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.
„� .d r 4
Electrical Permit Applica •]Tt r I OR OI.1 I( I. l tiF ONL1
City ofTigard y 7 Received (.
SIN 2�! /_O1 Date/B4Air �' Penmtlt �-�p �t7',OC/3
13125 SW Flail Blvd.,Tigard,OR 97 Plan Review
t m Phone: 503.718.2439 Fax: 503.598.19b { ?y ��aRelated Permit#:
Inspection Line: 503.639.4175 �,t, kir, 1'IGtA,AU Ready Date/By: El See Page2 for
T I G A R D Internet: www,tigard-or.gov C`= Notified/Method: Supplemental Information
TYlE 1l PLAN REVWlEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more ❑Building over three stories.
0 Demolition 0 Other:
where the available fault current 0 Marinas and boatyards,
CATEGORY OF CONSTRUCTION exceeds 10,000 snips at 150 volts or 0 Floating buildings,
® 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
Multi-familyMaster builderamps for all other installations buildings.
❑ 0 ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION. ., ❑Emergency system, larger separately derived
Job site address: (�/� C \ ❑Addition of new motor load of system
Job
C10 S(I Ann Ck e,"e_ 100ItP or more. ❑"A” "E""I-2""1-1"
City/State/ZIP:Tigard' �Ore on 97223 0 Six or more residential units. occupancy.
Tigard, ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.4: Project name: 0 Hazardous locations. 0 Supply voltage for more than
i-� �1 ❑Service or feeder 600 amps or more. 600 volts nominal
Cross street/directions to job site: 5k) q 5' A t,e YlL'5 _. FEE SCHEDULE
Description I Qts. i Each I Total 1 '
� New residential single-or multi-family dwelling unit.
Subdivision: Ll� \ U i l lc'3 V Lot#: C Includes attached garage.
tt �^ 1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft or portion 3392 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
NEW RESIDENTIAL CONSTRUCTION (with above sq.ft.)
Limited energy,multi-family 75,00 2
residential(with above sq.ft.)
Renewable Energy C) See Page 2
_� PROPERTY OWNER :1 Q TEKANT Services or feeders installation,alt tion,and/or relocation '
Name:SAGE BUILT HOMES LLC 200 amps or less ,r 100.70 2
Address: 1815 NW 169TH PL.SUITE 1040 201 amps to 400 amps 13336 2
401 amps to 600 amps 200.34 2
City/State/ZIP:BEAVERTON,OR.97006 601 amps to 1,000 amps 301,04 2
Phone:(503)533-5167 Fax:(503)533-5167 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 I
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
o� APPLICANT i 0 CONTACT pEnsoN Branch circuits—new,alteration,or extension,per panel
, A,Fee for branch circuits with
Business name:SAGE BUILT HOMES LLC above service or feeder fee, 7 42 2
(���,� each branch circuit
� WU
Contact name: P)e13.Fee for branch circuits without
Address:SAME AS ABOVE �" servicer feeder fee,first / 56.18 2
circuit
circuit
City/State/ZIP: Each add'[branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
67,84
dwelliEmail:Ron @SAGEBUILTHOMESLLC.COM nservice and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Ross Electric Sign or outline lighting 67.84 2
Address:2870 SE 75th Avenue,203 Signal circuit(s)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP:Hillsboro,Oregon 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr mmn) 66.25/hr
Phone:(503)642-2800 Fax:(503)642-5815 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 Lie.: 157891 Electrical Lie.: 34-436C Suprv.Lic.:7�- _C specificallx listed('/Z hr min)
Suprv.Electrician signature,required: 4 enucA,,L Pottier
Subtotal: , /,
Print name: Date: 0 Plan Review Required(25%of permit fee):
" ) State surcharge(12%of permit fee): - '7f
Authorized signature: e.:
, 7- t�TOTAL PERMIT FEE: G}r7-
This permit application expires if a permit is not obtained within ISO
Print name: 1. 1� pe(' Date: days after it has been accepted as complete.
i * Number of inspections allowed per permit.
tlriuilding\Permits11EI C_PermitApp_ELRERE doe Rev 06117/2015 440-4615r(11/05/COM/WttB
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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 July 24, 2018 at 10:41 :12 AM
Record Type: Record ID:
Residential - Electrical ELC2018-00436
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Electrician to plug un used port in outside j box to make weather tight.
Violation Summary:
Inspector Contractor