Permit (179) IVCITY OF TIGARD ELECTRICAL PERMIT
I
' COMMUNITY DEVELOPMENT Permit#: ELC2019-00217
TIGAR^D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/03/2019
Parcel: 1 S 136CA04300
Jurisdiction: Tigard
Site address: 11080 SW 79TH AVE
Project: OSBRINK Subdivision: FRIENDLY ACRES Lot: 5
Project Description: (2)branch circuits for furnace and A/C.
Contractor: OWNER Owner: OSBRINK, JOSHUA T
JOSHUA&ANNY OSBRINK OSBRINK,ANNY H
11080 SW 79TH 11080 SW 79TH AVE
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 971-336-9028 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 04/03/2019 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 04/03/2019 $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 issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow thea d—bthe 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�irect que.tions to OUNC by calling 503.232..1199 1.800.332.2344.
Issued By: %%�,-�^- �' Permittee Signature: ,�C7:5_._... :2-----c-----4.. `
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 orrici: t sl: 0\1.1
City of Tigard ® Received
`' Date/B : /'` *Jur
MUMI
ul 13125 SW Hall Blvd.,Tigard,OR 972 �i\V Plan Review
t11 11 Phone: 503.718.2439 t t V + Date/B : Related Permit#: �'f c );
Email: TigardBuildingPermits@7�1br.gov qo\CS Ready Date/By: IMIIIII H See Page 2 for
T I G K D Inspection Line: 503.639.4175 Inter ahwww. gard-my Notified/Method: Supplemental Information
TYPE OF WORCKKy flF1\vIn.s\VON PLAN REVIEW
0 New construction ®Addition/alterataFc4A Cnt Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition ❑Other: 0-v- 0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
xi 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amp❑Multi-family ❑Master builder 0 Other: Fire for all other installations. butdngs.
0 Fire pump. Installation❑ of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 1/0 60 j to, 9 Li 1001W or more. ❑"A","E","l-z",°°1-3",
City/State/ZIP: t Ct� Gi-7_1_, ...R.
Six or more residential units. occupancy.
/ , Health-care facilities. ❑Recreational vehicle parks.
0 Hazardous locations. ❑Supply voltage for more than
Suite/bldg./apt.#: Project name: Os ��IryI_ /� amps600 volts nominal.
0 Service or feeder 600 or more.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
z e AfE c IZ t- (with above, t)
C{� /`t Ulf+' Nl P � - L Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
❑ PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: i�t'ltj a Jo)l i-ftr f t 200 amps or less 100.70 2
Address: l i'(,� 201 amps to 400 amps 133.56 2
ila"rea ,...v ..�
‘7"-,.,.
^ n 401 amps to 600 amps 200.34 2
City/State/ZIP: 1 . i1.,t. , (, _�,f�,� 601 amps to 1,000 amps 301.04 2
Phone:(97 j') 6 gi.a69 Over 1,000 amps or volts 552.26 2
/ Temporary services or feeders installation,alteration,and/or
Email:
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''9' � 4,„,..._ ;I. 7,449,670,and 701. 201 amps to 400 amps 125.08 2
4 r�req 401 amps signature: _ _ Date: to 599 amps 168.54 2
`CANT 1 El C ACT PERSON Branch circuits-new,alteration,or extension,per panel
�,f A.Fee for branch circuits with
C V
Business name: r`ky/y)t?- 74/1- 72C)12'
1)"'-'17-4-
e.- /c above service or feeder fee, 7 42 2
+` each branch circuit
Contact name: '?`-s _.rZeed B.Fee for branch circuits without
Address: �} /,'`"T� service or feeder fee,first 56.18 ,5a./ 2
/ . CDU E�;,� , l�tsll branch circuit i
City/State/ZIP: Z),--�j _ "",1 de .,)-) J Each add'I branch circuit 1 7.42 7 11).. 2
/ ,. t I Miscellaneous(service or feeder not included)
Phone:( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed('/z hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 63.[o J
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): '?„(3
Authorized signature: TOTAL PERMIT FEE: ` '7/,
This permit application expires if a permit is not ottained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 440-4615T(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
De
Fee for all residential systems combined: $75.00I
Renewable Qty. Each I Total *
electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
El Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
El 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)
El 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 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/z hr mm)
COMMERCIAL;WORKONLY =shy ELECTRICAL I°ERvitt
����
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
El 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
Tel: 503.718.2439
Location: Inspection Date:
11080 SW 79TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Electrical ELC2019-00217
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Minor label installed.
ELS 702715
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
11080 SW 79TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Electrical ELC2019-00217
Inspection Type: Inspector:
199 Electrical final David Young
Result:
FA I L
Comments:
licensed electrical contractor to be added to permit to take responsibility for electrical
work not done by homeowner per phone conversation 4/4/19.
Violation Summary:
Inspector Contractor