Permit Support Document CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a - COMMUNITY DEVELOPMENT
Permit#: ELC2017-00168
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 k Date Issued: 03/10/2017
T f c.a It Dg / /`` Parcel: 2S103CB04200
Jurisdiction: Tigard
Site address: 12270 SW MARION ST
Project: marion st. Subdivision: WILLAMETTE NO.2 Lot: 21
Project Description: Bathroom remodel. 7/24/18:REPRINT to add(1)branch circuit for(6)can lights in living room and(1)can light in
bedroom.
Contractor: PARAMOUNT ELECTRIC CO Owner: PRICE,JOHN H&NORMA J
39085 PIONEER BLVD STE#203 12270 SW MARION ST
SANDY, OR 97055 TIGARD, OR 97223
PHONE: 503-703-2571 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Branch Circuits wo/Purchase Service or 03/10/2017 $63.60
Feeder
12%State Surcharge-Electrical 03/10/2017 $7.63
Type of Use: SF Branch Circuits w/Purchase Service or 07/24/2018 $7.42
Class of Work: ALT Feeder
Total Number of Systems: 12%State Surcharge-Electrical 07/24/2018 $0.89
Audio&Stereo: N
Security Alarm: N
Garage Door Opener: N
HVAC: N
Vacuum System: N
Other: N
Other Desc: Total $79.54
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 issuanc- 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 •- er. 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 503.2 :87 or 1.800.332.2344.
/Issued By: Permittee Signature: Á..
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 Application - -- FOR OFFICE USE ONLY
Cityo Tigard JUL 2 . `2018 Received
g Date/B : 4 , i/'A / .
11111 q 13125 SW Hall Blvd.,Tigard,OR 97223 ' Plan Review
= Phone: 503.718.2439 Fax: 503.598.1960 s.1 Date/B : Related Permit#:
Inspection Line: 503.639.4175 E5U:1 ,• 1, v,,.,'1tieadyDate/By: June 63 See Page 2 for
TIGARD Internet: www.tigard-or.gov Notified/Method: Supplemental Information
.s .t...
'. :'TYPE OF'WORK . Print name: 1
U New construction 14 Addition/alteration/replacement
❑Demolition ❑Other: PLAN REVIEW
Please check all that apply(submit 2 sets of plans w/items checked):
CATEGORY OF CONSTRUCTION '
❑Service or feeder 400 amps or more ❑ Building over three
1-and 2-family dwelling LI Commercial/industrial U Accessory building where the available fault current stories.
❑Multi-family ❑Master builder ❑Other: exceeds 10,000 amps at 150 volts or ❑ Marinas and
JOB SITE INFORMATION AND LOCATION less to ground,or exceeds 14,000 boatyards.
r amps for all other installations. ❑ Floating buildings.
Job#: Job site address: (Z7_ & ,,G J`WI ❑Fire pump. ❑ Commercial-use
City/State/ZIP: fL G (' 4 ❑Emergency system. agricultural
J ❑Addition of new motor load of buildings.
Suite/bldg./apt.#: Project name: 100HP or more. ❑ Installation of 150
Cross street/directions to job site: III Six or more residential units.
KVA or
larger separately derived
❑ Health-care facilities. system.
❑ Hazardous locations. ❑ "A","E","1-2","I-
Subdivision: Lot#: ❑ Service or feeder 600 3",occupancy.
amps or more. ❑ Recreational vehicle
Tax map/parcel#:
parks.
DESCRIPTION OF WORK ❑ Supply voltage for
e Q6 i ^ rA f, F., '-51,',1,
p1,' t-,,i1cL-c 7_/�qt` ( more tha 600 volts nominal.
tSl'i--.'1' G. C-e�.,..A 1:1)%-"A-1--
y 11))1 �'t'L'" i ( (--C4-c-- / Cr/jE2. FEE SCFIEDULE
U'PROPERTY OWNER U TENANT Description I Qty. [ Each I Total 1"
New residential single-or multi-family dwelling unit.
Name: Includes attached garage.
Address: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 _ 1
City/State/ZiP: Limited energy,residential
(with above sq.ft.) 75.00 2
Phone:( ) Fax:( ) Limited energy,multi-family 75.00 2
Email: residential(with above sq.ft.)
Renewable Ener U See Page
Owner installation: This installation is being made on property that I own which is not Energy 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. Services or feeders installation,alteration,and/or relocation
Owner signature: Date: 200 amps or less 100.70 2
. LiAPPLICANT U CONTACT PERSON 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Business name: 601 amps to 1,000 amps _ 301.04 2
Contact name: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Address: relocation
City/State/ZIP: 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Phone:( ) Fax: :( ) 401 amps to 599 amps 168.54 2
Email: Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits w_ C `' ',
. - CONTRACTOR above service or feeder tee,
Business name: farait"-r� z�f- C '.e f.4. /74___. each branch circuit 7'42 �.�'� 2
JB.Fee for branch circuits without
Address: etf' 5`72 se cct L,.IA }.41,, service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: `J c C -c t cn2.-_ 9 7,97 > Each add'l branch circuit 7.42 2
� q ,.� Miscellaneous(service or feeder not included)
[
Phone:( 1 w Zi L 1--,a 6' Fax:( )
Each manufactured or modular
r r dwelling,service and/or feeder 67.84 2
Email: r`94. 54�� r l tn._- tj�.. t G,.�yi,•.— Reconnect only 67.84 2
CCB Lic.: pt.c3.4 ', Electrical Lie.: G.—8157 Suprv.Lie.: 4/8 2,75 Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
Suprv. Electrician signature,required: tA,vQ.t-,,--r -,..„-----
Signal circuits)or limited-energy LI See Page
2
Print name: I/1i,,Gtti rr c Ci(,/n-+-- Date: 7 pe—/f panel,alteration,or extension. 2
Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Authorized signature: ,�
� Investigation(1 hr min) 90.00/hr
•
I\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-46151(11/05/COM/WEB -.2., VA..),
r
Indust-ial dant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
ELECTRICAL PERMIT FEES
Subtotal:
LI Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180 days after it has been accepted as
complete.
* Number of inspections allowed per permit. •
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/I7/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12270 SW MARION ST, TIGARD, OR, 97223 July 25, 2018 at 12:11 :28 PM
Record Type: Record ID:
Residential - Electrical ELC2017-00168
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor