Permit Support Document CITY OF TIGARD ELECTRICAL PERMIT
#C COMMUNITY DEVELOPMENT Permit#: ELC2019-00571
Date Issued: 8/28/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 f/4-72, ( G parcel: 2S103DB00100
Jurisdiction: Tigard
Site address: 13030 SW 115TH AVE
Project: Borow Subdivision: None Lot:
Project Description: Replace feeder to garage and panel with ground rods. 7/15/2020: REPRINT permit to add(14)branch circuits.
Contractor: LM ELECTRIC LLC Owner: BOROW, HARLAN S
PO BOX 493 PACIFIC EVERGREEN HOMES LLC
NEWBERG, OR 97132 13030 SW 115TH AVE
TIGARD, OR 97223
PHONE:
PHONE: 503-858-4428
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 08/28/2019 $100.70
Specifics:
amps or less
1 ea 12%State Surcharge- 08/28/2019 $12.08
Type of Use: SF Electrical
Class of Work: ALT 14 crt Branch Circuits w/Purchase 07/15/2020 $103.88
Service or Feeder
Type of Const: 0 ea 12%State Surcharge- 07/15/2020 $12.47
Occupancy Grp: Electrical
Total $229.13
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 the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952- -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ,�7'�u'-�C tfil--.---' Permittee Signature: f rk/ •`/`1d°L i C let
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.
B ECt\ r r ^_
Electrical Permit Application 1 v c tt)It tll 1 It I. I .r (INI
City of Tigard ReceivedJUL ®7 2020 Dare/By: 7/is`2() -eV Penni":CLC 24/9-00S7/
13125 SW Hall Blvd.,Tigard,OR 97223 _ Plan Review
' II. Phone: 503.718.2439 Fax: 503.598.19e.,-„/ r Da eB : Related Perm t a:
t.,st 1 d Lir v\lA Y
T I GARI7 Inspection Line: 503.639.4175 st. E l t e l y,t r, 1-i'\rt l C ' Ready Date/By: turfs: 1121 See Page 2 for
Internet: wwwugard-or.gov Ntitified/Method: Supplemental Information
TYPE OF WORK PLAN ,f it cr(y*ac,Iiar j;i;
❑New construction Pg.-Addition/alteration/replacement Please check all that apply(submit/sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition El Other:
where the available fault current ❑Marinas and boatyards.
CATEGORY..OF CONSTRUCTION :. exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building lass to ground,or exceeds 14.000 ❑Commercial-use agricultural
Multi-familyMaster builder rrypf�Other: tt�p amps for all other installations. buildings.
❑ ❑ ICy.. //7 t'+t.a4P 0 Fire pump. 0 Installation of 150 KVA or
'_l- JOB SITE INFORMATION. AND LOCATION 0 Emergency system larger separately derived
d U l ( � ❑Addition of new motor load of system
Job#: Job site address:
3 Ave_ 100HP or more. ❑..A..„E�. 'l-2 ,.1 3'•,
City/State/ZIP: ''"1� F� ^ ❑Six or more residential units. occupancy.
t c „r t 1 y _ - i-2 Z l ❑Health-care facilities. El Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: 0 Hazardous locations. ❑Supply voltage for more than
❑Service or feeder too amps or more. 600 volts nominal.
Cross street/directions to job site: FE'E SCHEDULE
Description I Qty. I Each I
Tail I
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tar map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or ponion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
r6-ptc/t l Y tit/ct et. / r ( e)4\ (with above sq.ft} 75.00 2
�'"` Gt Gut ci `j`°^') 'Kt,v Limited energy,multi-family 75.00 2
1.--::::'
-� �y t 1 ev 9 et.e°`v...`""'C residential with above ft.)
Jj L-C" 2°t 9 -c'-'6 f } (TIT C1‘v S)-*�ti�t`""`457( 2 '' *�) Renewable Energy 0 See Page 2
IRT PROPERTY OWNER 0 TENANT
Services or feeders installation,alteration,and/or relocation
Name: 14 -t ok., B 0 roL,,d _ 200 amps or less 100.70 2
Address: 130 O Sf .) I t e_ 201 amps to 400 amps 133.56 2
t} Cf (90_ 4 1 22' 601ampsto I,6000 200.34 2
Ci /StateJZIP: � (c1 T 601 amps to 000 amps 30
1.04 2
Phone:(%p'23) 49,.(3 itr ' Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is bein made on property that I own which is not 200 amps or less 59.36 i
intended For sale,leas nt,or . h , rding to ORS 447,449,670 ai dd 701.7 201 amps to 400 amps 125.08 2
Owner signature: j Date 7/•-/!77 401 amps to 599 amps 168.54 2
fa-
APPLICANf 0 CONTACT PERSON Branch circuits-new,alteration,or extension,Per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, u
Contact name: each branan circuit
r / 7.42 2
40.t,N„ ��(,�tn,.' B.Fee for branch circuits withtrut
/�'�ve service or feeder fee,first
Address: (7�y Skil 1'; i. 1^7 branch circuit 56.18 2
City/State/ZIP: "'ram G./ V 1 tT l ,2.'2-'25 Each add''branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(gbh) 7-1 45 --£j(0 21- Fax: :( ) Each manufactured or modular
i1� dwelling,service and/or feeder 67.84 2
Email: //v bojct+J. ..1#at,ctt t,cCuAe) Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: A4A G.- tGC / t� Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 See 2 2
Address: ) D x 4'- , panel,alteration,or extension. Page
` _ �� 32.
Each additional inspection over allowable in any of the above
City/State/ZIP: Gw1 G'�! O ei 1 Additional inspection(1 hr min) 66.25/hr
Phone:(513 ) &'5-8- I-,L.j 215- Fax:( ) Investigation(I hr min) 90.00/hr
Email: Lptc to /r,c. it,ta,1..pp •Gt74a^ Industrialplant(Ihrmin) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: I Q(cr-99 Electrical Lic.: C see . Suprv,Lie.: specifically listed('/t hr min)
ELECTRICAL PERMIT
Suprv.Electrician signature,required: G t FEES
2�')L{,Tr.VL G1.t �,
il r Ci�s. �,{�
Print name: d/Ady+-4„_ Date: q..,f"Z/n, 0 Plan Review Required(25%of permitSubt foecu)
( r ( State surcharge(12%of permit tee): / . i/7
Authorized sign TOTAL PERMIT FEE: // 4,�.5.
/J This permit application expires if■permit is not obtained within 180
Print name: / Date: ,yam{/a-, days after it has been accepted as complete.
rr ` / • Number of inspections allowed per permit.
1:1Build'mgtPerrnits\ELC_PermitApp_EI.R_ERE.doe Rev 1/6/I 712015 440.4615T(11/05/COM WEl
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL NTIAL WORK ONLY: FEE SCREDULE
Description Fee for all residential systems combined: $75.00 Renewable electrical energy C QtY. [ FAeh Tolal I *
systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 13356 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 20034 2
Wind generation systems in excess of 25 kva:
Burglar Alarm 25.01 to 50 kva 301.04 2
El Garage Door Opener* 50 01 to10o kva 552 26 2
>100 kva(fee in accordance 55226
with OAR 918-309-0040)
n Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >IOO 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
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(vs hr min)
COMMERCIAL WORT{ONLY ELECTRICAL PERMIT 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
II Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
U HVAC
n Instrumentation
❑ 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
1;1nuiIdtngTemetsV.I..C_permitApp EI-R_ERE.doc Rev 06,17/2015