Permit Support Document CITY OF TIGARD #
COMMUNITY DEVELOPMENT ELECTRICAL PERMIT
• / Permit#: ELC2020-00177
vZ� kr ,40 Date Issued: 3/30/2020
Tr G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102CB06801
Jurisdiction: Tigard
Site address: 10475 SW PARK ST
Project: Park Street Subdivision: 1992-092 PARTITION PLAT Lot: 1
Project Description: Rewire House. 7/27/20: REPRINTED permit to change contractor to owner installation.
Contractor: OWNER Owner: J&E HOME SOLUTIONS LLC
13301 SW 128TH PL
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
14 crt Branch Circuits wo/Purchase 03/30/2020 $152.64
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/30/2020 $18.32
Type of Use: SF Electrical
Class of Work: ALT 45 Misc Administration Fee 07/24/2020 $45.00
Type of Const:
Occupancy Grp:
Total $215.96
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 952-001-0090. 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: s l �7/4-'41-/e-4 1 Permittee Signature: 0/1-7- �/�G /C
—���� �J 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.
5 r
Electrical Permit Application nar�a �!1 n of !c F USE ONLY ���
yof TigardCE(Vt10 > �
'i - 312
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-� 13125 SW Hell Blvd.,Tigard,OR-97223 Plan Review ,. ,_
Phone: 503.718.F439 Fax: 503.598.1960 Date/11 : !'". .
Inspection Lite. 503 639.4175 JUL - Ready Date/By: IMAIIIFEENEMI
TIGARI) Internet: -ngard-or.gov Notified/Method:
TYPE OP WORK PLAN REVIEW
El New consort^D° Ellteration/reP Addition/alteration/replacement lacement 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.
0 Demoll
n ' Other: T`is (�11 1C cll.' 1 u-lwhere the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 votes or ❑Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
j'I-and 2-family dwelling ❑Commercial/industrial 0 Accessory building amps for all other installations. buildings.
ID Multi-family 0 Master builder 0 Other: CI Fire pomp. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job 4: Job site address:/U4.175 SLA" Poi*" ST- 100HPormore. ❑"A "E","I-Y',"I-3',
❑Six or more residential units. occupancy.
City/State/ZIP: �j(_7.,;� Oft q1 �3 ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt-#: Project name: ['Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: iti0.4 .;A S FEE SCHEDULE
Description 14rv. I Rash I Taal 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 I
DESCRIPTION OF WORK limited energy,residential 75.00 2
) l� (with above sq.ft.)
r ryt1J17C �'oA{ram, r +.JA. e..let -/j''�i,,7 Pc J."i+- Limited energy,multi-family
_I 5 /;w t h e l C c /,,,e 0_1. residential(with above sq.ft.) 75.00 2
��e Mt QLv.1ei` r..tll �,z CJ�+a+� t `� l C'r Renewable Energy 0 See Page 2
$'PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: br,'< C-i e c."a 200 amps or less 100.70 2
Address: /3 3 0 j S L..,,, a sea k r a Z 201 amps to aoo amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: ,-5 0,„A G£ 9 1 2.d 3 601 amps to 1,000 amps 301.04 2
Phone:(Sala' V y - 70/'I Fax:( ) Over 1,000 amps or volts 552.26 2
TempoEmail: �'n ro e Y µo. e $ i u 4, a r1 S. co re,... relocation
services or feeders installation,alteration,trna/Dr
Owner installation:Th' stallatici s being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lea nt,pr exc gel according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: //r11 Date:7 -1;-2'0L C' 401 amps to 599 amps 168.54 2
APPLICANT CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
)fifL A.Fee for branch circuits with
Business name: 3--1 E f.(rJNte S.�(�'ft c.7n S above service or feeder fee, 7.42 2
each branch circuit
Contact name: 6r1.(; &re a ft- B.Fee for branch circuits without
f, u„ service or feeder fee,first
Address: r/(3 33,21 St.., /1 1+ f L branch
circuit 56.18 2
City/State/ZIP:TI )i r U 1` 7 i,24 3 Each add'I circuit 7.42 2
y� Miscellaneous(service or feeder not included)
Phone:(S-o3 ) fp/ - 70/t{ Fax::( ) Each matattacnaed or modular 67.84 2
dwelling,service and/or feeder
Email: A FJ J fvlC SSG 1 Vlt.4 , L U el- Reconnect only 67.84 2
//CONTRAC`TOR Pump or irrigation circle 67.84 2
Business name: / /1 a / Sign or outline lighting 67.81
ll'�V Signal circuit(s)or limited-energy a See Page 2 2
2
Address: panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: )� Additional inspection(I hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(l hr min) 78.18/hr
Email: Inspections for which no fee is
specifically listed(11 hr min) 90.00/hr
CCB Lie.: Electrical Lie.: Suprv.Lio.: ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of pennit fee):
TOTAL PERMIT FEE:
t This permit application expires if a permit is not obtained within 180
Print name: 6 t.L 6--r e c.ti. 1 Dale: 1 -i)-ZoLc, days niter it Ins been accepted a complete.
Number of inspections allowed per permit.
1:tnaildiaalPermua\ELC_PervRAse ELR ERE.doc Rev 06/172015 440.4615T(11A5/COhhWEa
r .
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Descri •
Fee for all residential systems combined: $75.00 tion I Qty. I Each TotalI
Renewable�' Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to15kva 133.56 2
❑ 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* I00 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ 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 an of the above:
El Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr min) •
Inspections for which no fee is 90 0p/hr
specifically listed(G hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) ' Number of inspections allowed per permit.
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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