Permit CITY OF TIGARD ELECTRICAL PERMIT
f
i COMMUNITY DEVELOPMENT Permit#: ELC2019-00886
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/31/2019
T I G!1li n 9 Parcel: 2S110AD09900
Jurisdiction: Tigard
Site address: 10901 SW ANNAND HILL CT
Project: Annand Heights, Lot 1 Subdivision: ANNAND HEIGHTS Lot: 1
Project Description: Adding(1)branch circuit for the installation of an A/C unit.
Contractor: DREAMHOUSE ELECTRIC LLC Owner: ANNAND HILL LLC
221 SW MOONRIDGE PL BY RICHARDS, M DALE
PORLAND, OR 97225 12655 SW NORTH DAKOTA ST
TIGARD, OR 97223
PHONE: 503-648-5144 PHONE: 503-780-4375
FAX: 503-648-9723
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 12/31/2019 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/31/2019 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
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 yo to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OA -001-009 You obtSin a co of the rule r direct questions to OUNC by calling 503.232.1987 or 1.800.3322...22344.
C
Issued By: Permittee Signature: V� --/ 4/� •
OWNER INSTALLATION ONLY /�
The installItion 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 2111
City SW Trd Received
Dafe/EY: / Pk6irt72.(e.,,i/ -C-e,'‘if,FF6'
, ,....---• 13125
of Hall iga Blvd.,Tigard,OR 9722-i r Plan /
Review
• g Phone: 503.718.2439 Fax: 503.598 19tC Dateay:
Inspection Line: 503.639.4175 Ready Date/By: Juris 0 See Page 2 for
•::.J.
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
ew construction t ft 1
0 Addition/alterat4eitttns,teripl v i ' 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 CI Other:
where the available fault current 0 Marinas and boatyards.
. . . . • . . . ..
exceeds 10,000 amps at 150 volts or 0 Floatrng buildings
Cl ag D 1-and 2-family dwelling Ej Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 Commercial-use ricultural
amps for all other installations. buildings.
0 Multi-family CI Master builder 0 Other: El Fire pump. 0 Installation of 150 KVA or
.-.,,T4I, 17:..'' .7...'.i,;gt.:.:::.2,7 ID Emergency system. larger separately derived
°Addition of new motor load of system.
Job#: Job site addres 40 alfifff/ 1 ( 100HP or more
0 Health-care facilities.City/State/ZIP. /1/4.i)• Qc- 972-2- 0 Six or more residential units.
occupancy.
C
0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:/19-ibetaitd #59 A 1 0 Hazardous locations. 0 Supply voltage for more than
600 volts nominal.['Service or feeder 600 amps or more.
Cross street/directions to job site: bln M -I,e7, ';'-:i:::,.-:441.iraT't....:',-,2.. ''''.7-1...2".;',F -,':.:1•::iffe.;1'.4..
t‘i7 Description Qtr. Each Total •
New residential single-or multi-family dwelling unit.
Subdivision: ii-Anaftel life)i# I Lot#: / Includes attached garage.
1,000 sq.fl.or less r 1 168.54 4
Tax map/parcel#:
Ea.addl 500 sq.ft.or poftion ' 33.92 I
.. 'i•.'/'' littlitkigrA/%.411il/1315,geril/ir*./trig,"'', Limited energy,residential -
Li) c,'" 4 Li
e(1 tv- (with above sq.ft.)
mited energy,m 75.00 2ulti-family _
75.00 2
s residential(with above sq.ft.)
.1 :‘,...'",': ' ':,:' 13$11Mifir,: •;:;,-.7,:,, ,.. „,,:: Services or feeders installation,alteration,and/or relocation
Name: &if wad 61-Seruc,A4 JAC- 200 amps or less 100.70 2
. _
Address: /2q73-45- 6'4,-," ittee-Ol .lit 61/f / 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 9'La/ &C_ 123 601 amps to 1,000 amps 301.04 2
Phone:(5e • ba_ill 7t— 1 Fax: (6743 )MI —74a, Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:fAjhcrlipfrestialliattrS /111.0.0 0 641.64 I ,e-cot 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 snips 125 08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
.r,.,.. ,;--.-:..... ... . 2,, ,..;24.‘,3:1E61.1.Tr 10-51-.1„:"--i„.-,..t.:-.._-.....:.,57;.. , : .:?--....4: 1:.;;; .7' ABrapnchf circuits-bh cinewuits,alteration,or extension, r panel
Business name: jahte above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without '
service or feeder fee,first
Address:
branch circuit 1 56.18 2
City/State/ZIP: Each addl branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
67 84 2
dwelling,service and/or feeder
Email:
, _ Reconnect only 67.84 2
,-.0**sigl4itt,.:7:1 ',7':::•''.tf'k. 4.` ..'t•' ..- ;'-;-' Pump or i„igation circle
' Ar
iinm 67.84 2
Business name: t? 640.5( friraeit.. sSiiggrinalorcoi ructuliint(o eliorghltg limited-energy
67.84 2
Address: .2sa/ 1-(4...J /noon 1-14„- pi panel,alteration,or extension. 0 Ste Page 2 2
City/State/ZIP: D),--H(iti
Each additional inspection over allowable in any of the above
ifr cyc. er2,1_)-5
Additional inspection(1 hr min) 66.25/hr
Phone: •••-63) /.7 _.6-71,/ Fax:(5-t,3) g yb_970,1,3 Investigation(1 hr min) 90.00/hr
Industrial plant(I hr min) 78.18/hr
Email:
-
Inspections for which no fee is
hr
CCB Lic.:/142a4 Electrical Lice,— ' Suprv.Lic.:115-405 specifi )4call listed hr min ,:,
4,cr.. ';r'''''''' .''rl ''' t; ' 90.00/;':. ..C)1 .",I •f//,..E,.*:,,e,,i,4401,
Suprv.Electrician signature,required:
Subtotal:
Print name' .. ri,s5 higtio I Date: fii/bki, 0 Plan Review Required(25%of permit fee):,
40f
210z=0,
State surcharge(12%of permit fee):
Authorized signature. 7;
TOTAL PERMIT FEE:
This permit application expires if.permit is not obtained within 180
Print name: C r-1'D n'tc, Itiv-Ac, Date: / 6, days after it has been accepted as complete.
" Number of inspections allowed per permit.
1\Building1Perynas\ELC_PernutApp_ELR ERE.doc Rev 06/1 /21•11 440-46/5T(11/05/COMIWEE3