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Permit Support Document CITY OF TIGARD ELECTRICAL PERMIT :illISI ' COMMUNITY DEVELOPMENT Permit#: ELC2018-00527 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 1 ,.. I Date Issued: 08/09/2018 T i C AId'O 9 V ,\\C W Parcel: 2S104BC01200 '- '5 Jurisdiction: Tigard Site address: 14504 SW FERN ST Project: Kaufer Subdivision: HILLSHIRE HOLLOW Lot: G Project Description: Adding service panel with(7)branch circuits.3/28/19:REPRINT to add(13)additional branch circuits. Contractor: BRIGHTSIDE ELECTRIC&LIGHTING SERV Owner: KAUFER, GREGORY A REVOCABLE TRUS PO BOX 930 KAUFER,VALERIE J REVOCABLE TRUST CARLTON, OR 97111 14504 SW FERN ST TIGARD, OR 97223 PHONE: 503-852-7900 PHONE: FAX: 503-852-9573 FEES Quantity Description Date Amount 1 ea Services or Feeders-200 08/09/2018 $100.70 Specifics: amps or less 7 crt Branch Circuits w/Purchase 08/09/2018 $51.94 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 08/09/2018 $18.32 Electrical Type of Const: 13 crt Branch Circuits w/Purchase 03/28/2019 $96.46 Occupancy Grp: Service or Feeder 0 ea 12%State Surcharge- 03/28/2019 $11.57 Electrical Total $278.99 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspefded for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cent=r die`rule `are--.set forth in OAR 952-001-0010 through OAR 952-001-0090. You mayobtain a copyof the rules or directquestions to OUNC bycalling5'•. 9; •r 1.8m. 4:.. . 9 / - ?.., Issued By: � Y v � Permittee Signature: ' �/� ''.-='�► OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Application_ roR 01.11(I. I_L 0v1.1 City of Tigard i . , Received Date/B : 3`a$ `I k C rEMEN — 13125 SW Hall Blvd.,Tigard,OR 97223 p r r,, Plan Review C Phone: 503.718.2439 1A, 2 "wig Date/B : Related Permit#: Email: TigardBuildingPermits@Tigard-or;gov Ready Date/By: Juris: ® See Page 2 for IIGAKD Inspection Line: 503.639.4175 Internet: www.tigard-or.gov` Notified/Method: Supplemental Information 1_�i—i.�. ,.J,`d•. -r.16J TYPE OF WORK 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. El 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. and 2-family dwelling ❑Commercial/industrial ❑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: ❑Fireum . p p 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION n 0 Emergency system. larger separately derived Job#: Job site address: 1 s`'(' tom, ❑Addition of new motor load of system. 5(7 tel, i-e- 1�1 100HP or more. ❑«A» «E» «1.2» «I.3„ City/State/ZIP: �� et, r ,4v� ' ❑Six or more residential units. occupancy. • 2 .V r<fi . ' ■Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: '$ t�Hazardous locations. 0 Supply voltage for more than ■Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: '>\7` FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: I Lot#: Includes attached garage. Tax map/parcel#: - 1,000 sq.ft.or less 168.54 4 Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential - \ (with above sq.ft.) 75.00 2 \ ` c -L `� r 0.1 6 ‘ 7)--- "L''INA---"' Limited energy,multi-family residential(with above sq. 75.00 2 V C2o4<g Uo s a3 ft. ) Er PROPERTY OWNER © TENANT Renewable Energy 0 See Page 2 Services or feeders installation,alteration,and/or relocation Name: F - to � � �v 200 amps or less 100.70 2 Address: \ 4 � +-_e_ ,�_ 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: , 1 CS- I� 601 amps to 1,000 amps 301.04 2 Phone:(, ) 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 j 0 CONTACT PERSON Branch circuits-new,alteration,or extension, er panel A.Fee for branch circuits with Business name: above service or feeder fee, 3 7.42 2 each branch circuit Contact name: B.Fee for branch circuits without service or feeder fee,first Address: branch circuit 56.18 2 City/State/ZIP: Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) 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:' ctc t:- laC . ,1.__.. Sign or outline lighting 67.84 2 Address: } [ l Signal circuit(s)or limited-energy - \ l3 panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: Z�v_1- � k , c\--,`� Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(c5(21 cj'4,.- ,,SCC 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.:\t"- C Electrical Lic.2- U-11.1s;Q Suprv.Lic.: �c ( specifically listed('/z hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: (4(ji .c ' c' 'N.;,:).1.c8 _ASI, Subtotal: Print name: I Date: I 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: .,,_a,,,' 4j_ Date: '/ 2 )c/ days after it has been accepted as complete. '> {S * Number of inspections allowed per permit. I:\Building\Permits\ELCPermitApp_ELRERE.doc Rev 10/26/2017 0-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Description Qty. I Each I Total 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 n 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 ❑ Garage 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 ❑ 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 6625/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed 2_hr!Mil) CCS RCIAL£'WORK ONLY E "AL. FEES 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 ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation n Intercom and Paging Systems ❑ 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_PermitApp_ELR_ERE.doc Rev 10/26/2017 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 14504 SW FERN ST, TIGARD, OR, 97223 March 11 , 2019 at 12:12:52 PM Record Type: Record ID: Residential - Electrical ELC2018-00527 Inspection Type: Inspector: 199 Electrical final David Young Result: FA I L Comments: Electrical for 7 branch circuits, add additional 13 branch circuits to permit. Note: prior to final inspection gas range to be removed as pool house not permitted as ADU. Bath fan and range not on mechanical permit. Violation Summary: Inspector Contractor City of Tigard Tel: 503.718.2439 Location: Inspection Date: 14504 SW FERN ST, TIGARD, OR, 97223 March 29, 2019 at 7:49:52 AM Record Type: Record ID: Residential - Electrical ELC2018-00527 Inspection Type: Inspector: 199 Electrical final Jeremy Burrows Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor