Permit Support Document CITY OF TIGARD ck
ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2020-00220
(S ZC) . Date Issued: 04/30/2020
T f GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 1 S134CD01000
Jurisdiction: Tigard
Site address: 11735 SW KATHERINE ST
Project: Finkel Subdivision: LERON HEIGHTS NO.3 Lot: 80
Project Description: new circuit in bath for remodel. 5/15/2020: REPRINT permit to add(1) branch circuit for range.
Contractor: GREEN BOX MECHANICAL Owner: FINKLE, BENJAMIN STEPHEN & BRITT
3265 NW 29TH AVE 11735 SW KATHERINE ST
PORTLAND, OR 97210 TIGARD, OR 97223
PHONE: 503-222-0555 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 04/30/2020 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 04/30/2020 $6.74
Type of Use: SF Electrical
Class of Work: ALT 1 crt Branch Circuits w/Purchase 05/15/2020 $7.42
Service or Feeder
Type of Const: 0 ea 12%State Surcharge- 05/15/2020 $0.89
Occupancy Grp: Electrical
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 the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OA 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: �7�/( /, JlP'�df6— Permittee Signature: C�� ,e �'7Ly�%�
v 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 603.639.4175 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 RECEIVE FOR OFFICE USE ONLY
Received �� ���d
City of Tigard Date/B ..—
Mk( / 2v v Permit#:�G�
It • 13125 SW Hall Blvd.,Tigard,OR 97223 13 2020 Plan RevF Related Permit#:
Phone: 503.718.2439 Fax: 503.598.1960 Date/B
Inspection Line: 503.639.4175 TiGAR Ready Date/By: RI See Page 2 for
TIGARI? CITY OFSupplemental Information
Internet: www.tigard-or.gov Sut�n�(l(a plvlS)�I otified Methods �y ?�J ��I pp
TYPE'OF WORK- ;'° e t"s,Li a ':v_ PLAN REVIEW
❑New construction ® Addition/alteration/replacement Please check all that apply(submit2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition D Other:
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
El 1-and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building less to ground,or exceeds14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family ❑ Master huilder ❑ Other 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
AddJob#:Finkle Job site address: 11735 SW Kathryn St ❑100H ion of new motor load of system.
OOHP or more.
City/State/ZIP:Tigard, OR 97223 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Finkle ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qsy. I Each I Total I .
New residential single-or multi-family dwelling unit.
Subdivision: 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 ,i' Limited energy,residential
bove sq.ft.) 75.00 2
nd stove---e-Z6(%J eine-4f‘ :Fz'� 577� '�a'
/�� b.-Zs( /� . ' r r�nia energy,multi-family 15.00 2
f2 v/i5 [�-�c(S 77n/es— ,1-a`-77-17,e T ?'- IJ0.2' residential(with above sq ft.)
t,. Renewable Energy ❑ See Page 2
r 51i}ice " ,PROPERTY OWNER ❑ TENANT _ Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 _ 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) 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 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 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
® APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Green Box Mechanical above service or feeder fee,
each branch circuit 7.42 2
Contact name:Sarah Fit B.Fee for branch circuits without
3265 NW 29th Ave service or feeder fee,first
Address: ! 56.18 2
branch circuit
City/State/ZIP:Portland, OR 97210 Each add'I branch circuit LT/ 7 42 710—'2
Phone: ( 222 0555 pax; : Miscellaneous(service or feeder
666not included)
( ) Each manufactured or modular 67.84 2
Email: dwelling,service and/or feeder
sarah@greenboxmechanical.com Reconnect only 67.84 2
CON'1RACTOR Pump or irrigation circle 67.84 2
Business name:Green Box Mechanical Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 See Page 2 2
Address:3265 NW 29th Ave panel,alteration,or extension.
City/State/ZIP:Portland, OR 97210 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:(503-R22-0555 Fax:( ) Investigation(1 hr min) 90.00/hr _
Industrial plant(1 hr min) 78.18/hr
Email:Sarah@greenboxmechanlcal.com Inspections for which no fee is
CCB Lic.:214076 Electrical Lic.:C1271 Suprv.Lic.:3763S specifically listed(V,hr min) 90,00/In
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 71 yol—
V
)I P ' t name: Mark Erickson Date:05/13/2020 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): ' 1,9
17 Authorized signature: TOTAL PERMIT FEE: , 3 /
This permit application expires if a permit is not obtaine within 180
Print name:J.C. Kootnekoff Date: days after it has been accepted as complete.
* Number of inspections allowed er permit.
\1:'Building\PermitsELC_PermitApp_ELR M/
_ERE.doe Rev 06/17/2015 440-4615T(11/05/COWEB ( /J �.,/ti21 672 " a / 7---.
Electrical Permit Application -City of Tigard
Page 2-Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description _— Qly. Reel, '1'aml *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less l00.7o 2
5.01 to 15 kva 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
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>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 66.25/hr 1
charged at an hourly(l hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
COMMERCIAL WORK ONLY: ELECTRIC&PERMIT FEES
Fee for each commercial system: $75.00 Subtotal
on Page 1):
Number of inspections allowed perr perm permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ 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
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