Permit (137) CITY OF TIGARD ELECTRICAL PERMIT
71PerCOMMUNITY DEVELOPMENT
mit#: ELC2018-00660
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/08/2018
(GSR D' Parcel: 2S110DD11200
Jurisdiction: Tigard
Site address: 15550 SW 109TH AVE
Project: HUBBS Subdivision: SUMMERFIELD NO.13 Lot: 682
Project Description: Replacing(1)panel and altering(5)branch circuits.
Contractor: MCCAMMON ELECTRIC CORP Owner: DAVID HUBBS
5086 IKE MOONEY RD 15550 SW 109TH AVE
SILVERTON, OR 97381 TIGARD, OR 97223
PHONE: 503-720-0012
HONE: 503-559-8466
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 10/08/2018 $100.70
Specifics: amps or less
5 crt Branch Circuits w/Purchase 10/08/2018 $37.10
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 10/08/2018 $16.54
Electrical
Type of Const:
Occupancy Grp:
Total $154.34
Required Items and Reports(Conditions)
AI
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Special Codes ..d 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 i-suance, .r if ork is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificat•n , en- h• e rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy s or direct questions to OUNC by calling 51x;'.198 ..332.2344.
Issued By: Permittee Signature: �•` t`
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 a FOR OFFICE 1 SE ON Ll
{ Received
- y of 222��� Date/B : r(� t Permit#:
III13125 SW HallTigard 1T Blvd.,Tigard,OR
Cit97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.196n C T Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: MEI ®
See Page 2 for
T I G A R D Internet: www.tigard-or.gov e') Notified/Method: Supplemental Information
CITY OF T il3iktiC
TYPE oisti tNG DIVISION PLAN REVIEW
❑New construction E'Addition/alteration/replacement 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.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
[ l-and 2-family dwelling ❑Commercial industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family ❑Master builder 0 Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address' q Ave--. ❑Addition of new motor load of system.
55,-0 SW I 0! /'►V9'. l00HP or more. ❑
City/State/ZIP: ❑Six or more residential units. occupancy.
�� 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: �J�j� 0 Hazardous locations. 0 Supply voltage for more than
I J '/r" 600 volts nominal.
� ❑Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total
/VA e\E e /01 New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
/� QQ (with above sq.ft.) 75.00 2
g (,IKE ri L /- 7`t. I L 4 Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
e)egr7N b CI/LLvrr Renewable Energy 0 See Page 2
a PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: DAy 0 5 200 amps or less ,, 100.70 tw 10 2
D 5 y,� /O 9 Ave- • 201 amps to 400 amps 133.56 2
Address: /55-
401 amps to 600 amps 200.34 2
City/State/ZIP: 77 !v) 601 amps to 1,000 amps 301.04 2
Phone:(�rjb3l 7 ef-.1, --rid(Z Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: e/. ha 4,.S ? e o '#ft ,tit- relocation
Owner• stallation: is i . allation is bein. ii,de on property that I own which is not 200 amps or less 59.36 1
intend,i or sale,le. t,\i e.c . •', . cord g to ORS 4, ' .70,and 701. 201 amps to 400 amps 125.08 2
r ,, 401 amps to 599 amps 168.54 2
10 A I..• !< Date: . .
❑ APPLICANT ❑ CONTACT PE'Non.-- Branch circuits-new,alteration,or extension, 1 er panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 7 42 T3, i b 2
each branch circuit J
Contact name: B.Fee for branch circuits without
service or feeder fee,first
Address: branch circuit
City/State/ZIP: Each add'I branch circuit h� p, _, 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: C ' Sign or outline lighting 67.84 2
y� Signal circuit(s)or limited-energy See Page 2 2
Address: 5 0 "ice —I-14._z m exp✓1a2,1 K._,A panel,alteration,or extension.
0 � � g Each additional inspection over allowable in any of the above
City/State/ZIP: J 3 >'-v•\IJW 9'7 3 3 ( Additional inspection(1 hr min) 66.25/hr
Phone:£O j) 55 81. 6 (Fax:( ) Investigation(1 hr min) 90.00/hr
Email: A/1 / Industrial plant(1 hr min) 78.18/hr
"MCC C j l yyLyyl d c,,� L 6 ileL '� Inspections for which no fee is 90.00/hr
CCB Lie.: jzJ1 o Electrical Lie.:(( 2_ Sup .,Lie.: Wito ,‹ specifically listed(%2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: /--" __'±k.keieri Subtotal: 13 7
Print name: 4-,t V,� vV e ,wt.S. Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): `(y 5-11
Authoriz signa e: TOTAL PERMIT FEE: 13-it. -31..t
C. J _ This permit application expires if a permit is not obtained within 180
Print n e: Date: !(f_u days after it has been accepted as complete.
* Number of inspections allowed per permit.
L•\Building\Permits\ELC Permit p ELR doc Rev 6/17/2015 440-4615T(11/05/COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15550 SW 109TH AVE, TIGARD, OR, 97224 January 16, 2019 at
9:42:19 AM
Record Type: Record ID:
Residential - Electrical ELC2018-00660
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor