Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2020-00209
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/04/2020
Parcel: 2S102AB00912
Jurisdiction: Tigard
Site address: 12125 SW 92ND AVE
Project: Lawson Subdivision: KIMBERLY ADDITION Lot: 12
Project Description: (3)branch circuits for new bathroom.
Contractor: OWNER Owner: LAWSON, KAREN L
12125 SW 92ND AVE
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 04/24/2020 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 04/24/2020 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
•
•
Total $79.54
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 -001- 090. Y u may obtain copy of the rul or direct questions to OUNC by calling 503.232.1 87 or 1.800.3332 23444__
Issued By: i2i/ i'/ Permittee Signature: �'(.ry r
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 ApplicationR EC E IV ED `
City of Tigard. APR0triter,:: y ine '�D it LGGo30.20 -af�.209
Iiii•• 13125 SW Hall Blvd.,Tigard,OR 97223 2 2020 Plan Review
* Related Permit ii:
Phone: 503.7182439 Fax: 503.598.19 Date/By finis: see e 2 for
Inspection Line: 503.639.4175 ITrr OF TIGARD ReadyDate/ByPage
TIGARD Internet: www.tigard-or.gov BUILDING DIVISION Notified/Metbo♦d'rY/2 Y/e .41a Supplemental Information
( TYPE OF WORK �i/197L— /<-f Y>JLAN REVIEW
❑New construction AAddition/alteration/replacement 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.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
1 1-and 2-family dwelling 0 Commercial industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: I Job site address: / 1 f 25 , N� /9' L&' Z U 1' footle or more. ❑"A "s" '1.2„"1-3
r 0 Six or more residential units. occupancy.
CI /State/ZIP: ❑Recreational vehicle parks.
h �`'�}/�� ' (" .. y�Zz 3 ❑Healthcare facilities.
Suite/bld ./ t.#: 1 Project name: 0 Hazardous locations. 0 Supply voltage for more than
g ap600 volts nominal.
0 Service or feeder 600 amps or more.
Cross street/directions to job site:C E/e-%E,? .'7 FEE SCHEDULE n l Total I =
Description
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
�" r� / 75.00 2
L �;K /c;2 A'6JV2i--/� / /��. (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
,.,,- Renewable Energy 0 See Page 2
PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
7 `� /� ) 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: !` — Z/ /,//-1 � lam(/w>5C/4
Address:/2 /'y_� �'ce) S'�Op,-� (/G.7 �j 401 amps to 600 amps 200.34 2
City/State/ZiP: / `%&/1?. ;j 2 2,. 601 amps to 1,000 amps 301.04 2
Phone:(Jc07)5a —3 6 Z� Fax:( ) Over 1,000 amps or volts 552.26 2
Email: �(1 �, / Off` Temporary services or feeders installation,alteration,and/or
k/f>2E ,l 5 ,CJ g-F/t'G� i V relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 5936 1
intended for sa carding to ORS 447,449,670, d 701.
f� 201 amps to 400 amps 125.08 2
Owner signature: , sa -�- - - _ Date: / . -t/ 401 amps to 599 amps 168.54 2
- -'❑ APPLICANT ' ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A Fee for branch circuits with
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,rust 56.18 2
Address: branch circuit
City/State/ZIP: Each add'!branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2 1
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 See Page 2 2
Address: panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: Additional inspection(1 In min) 66.25/hr
Phone:( ) I Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(t hr min) 78.18/hr
Inspections for which no fee is 90 00/hr
CCB Lie.: I Electrical Lic.: Suprv.Lic.: specifically listed(%:hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 7/r(»
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): cr.,5-�—
Authorized signature: TOTAL PERMIT FEE: 97, $y
This permit application expires if a permit is not obtained within me
Print name: Date: days after it has been accepted as complete.
' Number of inspections allowed per permit.
I BuildinglPer its\FJr_PermitApp_ELR_ERE.doc Rev 06/17/2015 44D4615Di 1/05/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
Description ( Qty. I Each I Total 1 a
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 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
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
f] 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 QO 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(%5 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 allowed
Subtotal(Enter on Page l):
(SEE OAR 918-309-0000) * Number of inspections allowed pe permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
nBoiler 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*
11 ❑ Protective Signaling
[] Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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