Permit CITY OF TIGARD ELECTRICAL PERMIT
' 111
• COMMUNITY DEVELOPMENT Permit#: ELC2020-00201
Date Issued: 04/23/2020
i l t;A R.C) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103BB07400
Jurisdiction: Tigard
Site address: 12522 SW 123RD AVE
Project: MCGOWAN, Subdivision: LAKE TERRACE Lot: 2
Project Description: Relocating(1)200 amp service panel and adding(7)branch circuits.
Contractor: OWNER Owner: RODGER, MATTHEW
MOLLY MCGOWEN MCGOWAN, MOLLY BARBARA
12522 SW 123RD AVENUE 12522 SW 123RD AVE
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503-805-4911 PHONE: 503-805-4911
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 04/23/2020 $100.70
Specifics: amps or less
1 ea 12% State Surcharge- 04/23/2020 $12.08
Type of Use: SF Electrical
Class of Work: ALT 7 crt Branch Circuits w/Purchase 04/23/2020 $51.94
Service or Feeder
Type of Const: 0 ea 12%State Surcharge- 04/23/2020 $6.24
Occupancy Grp: Electrical
Total $170.96
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 Jaw) 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 5201-0090. You m tain a copy of the ruler direct questions to OUNC by calling 503.232.1987 or 1.800.332,2344.
Issued By: Permiftee Signature:
VVV 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.
II
D
11lectri'al Permit ADOlicatitpikc, dVE l (iR 011 ICE IISE Oy1 1
City of Tigard Ap R 6 2020 Received L .... ��-1 'e mil#: _ a►—C?'J`
IIIw 13125 SW Hall Htvd,Tigard,OR 97223 ARQ Plan Review
a Phone: 503.718.2439 Fax: 503.598.1 ( OF T lG �1 DateB . Related Permit#:
Inspection Line: 503.639.4175 p 1 l�(a`Qti� 1klN Ready Date/By: : ® See Page 2 for
1 IGARD Internet www.tigard-or.gov SV��� Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ,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 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building 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• target separately derived
�1, t� Cl Addition1r of new motor load of system.
Job#: p Job site address: ZbZZ SW IZ J ira Y1J�/ 1001�or more. ❑"A" "E" "1-2","1-3",
City/State/ZIP: �)(� p A 2 0 Six or more residential units. occupancy.
ty "1 Y c1/ fi� ❑Healthcare facilities. ❑Recreational vehicle parks.
t)� ['Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or mom.
Suite/bldg./apt.#: Project name: , 1... N 600 volts nominal.
Cross street/directions to job site: w a1 N Ut FEE SCHEDULE
Description I Qty. I Each I Total 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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK/ '^ l Limited energy,residential 75.00 2
r&l o vrL eA e cxY\f,A1 yainvt i arl (with nergy,bove q.11.)
7 1 Limited energy,multi-family 75.00 2
Gi F/il(` Reresnewable
eEnl ithr above sq.8.>
Renewable Energy 0 See Page 2
PROPERTY OWNER/- ID TENANT Services or feeders installation,alteration,and/or relocation
Name: IA \\ M L l7D W Ay\ 200 amps or less ( 100.70 2
Address: I Ztji' SW 1v ' VIX ANL,. 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: -, % / I ca' ZZ' 601 amps to 1,000 amps 301.04 2
Phone:(5D'f) S Qs .j4.11 11 Fax: Over 1,000 amps or volts 552.26 2
( ) Temporary services or feeders installation,alteration,and/or
Email: u at!/a inn oil 84( a''. (, relocation
Owner ini talladon:This illation id being made on property that I own which is not 200 amps or less 59.36 1
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: /141 ' Date: pi.f.OZ•f^' 401 amps to 599 amps 168.54 2
APPLIC ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 7 7.42 2
' each branch circuit
Contact name: S Am t. 115 Q W l%,/ B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
Each add'!branch circuit 7.42 2
CitylState/ZIP: 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
CONTRACTOR Nunn 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 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 la min) 78.18/hr
Email: Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lie.: Suprv.Lie.: specifically listed('A hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: I Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
l:t&ridmg\Permila\ELC_PermitApp EIR—ERE.doc Rev 06/17/2015 440 4615T(l i/O5/COM/NEB
•
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva orless 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
❑ 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 I
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed CA hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotaler permitter .
Page 1):
y ' Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
{� HVAC
C Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
IitBuildingd'ennits1ELC_PemtitApp_ELR_ERE.doc 12ev 06/17i2015
.tjt a to la.Na 1 era moat a aaagiaavaa ta,.as
City of Tigard Received Pewit#:
1 ' "I 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
f Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit t:
Inspection Line: 503.639.4175 Ready Date1By: faro: la See Page 2 for
1 I t,-1 I'.1 i Internet: www.tigard.or.gov Notified/Method. Supplemental Information
TYPE OF WORK PLAN REVIa,_ '. : p
❑New construction Is Addition/alteration/replacement Please check all that apply(submit> sets of plans w/hems checked):
❑Service or feeder 400 amps or more ['Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
x' - w. 7". .': s'" ``, ORY OF CONSTRUCTION exceeds 10,000 s nps at 150 votes or ['Floating buildings.
al_and 2-family dwelling ❑Commercial/industrial ❑ Accessory building less to grotmd,or exceeds 14,000 ['Commercial-use agricultural
sops for an other installations. buildings.
❑Multi-family ❑Master builder 0 Other: ❑Pim pump. ['Installation of 150 KVA or
..r' "D':.. . •" '.. '^ 0 Emergency system. larger separately derived
c g N A(YD,LOCATION 1
O 0 Addition of new motor load of system
Job# m Job site address: ‘7ilr�2 Sty t p-/ 'r Mir' 10OHP or more. ❑
❑Six or mom residential units.
City/State/ZIP: '(�Ql aYd o 7i7i� Recreation.
` ❑Health-care facilities. ❑occupancy.
veluck pub.
Suite/bld ./ t.#: I Project name: J ,' D ouvt i�O 4 ( ¶zt vn ❑Hamrdous locations. 0 Supply voltage far more than
8 aP 1 V�ff//r7'', 6W volt$nomiosl
❑Service a feeder 600 amps a more.
Cross street/directions to job site: •• • • "" s 13';
1 n. ptioa I . I F� Total i
�(1)A V'e,'1 New residential single-or multi-familydwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft,or less 168.54 4
Tax map/parcel# Ea.add'I 500 sq.R.or portion 33.92 1
y, '; ,r.fr Limited
�. a .Fct ,`�. �, .e�v: .n .;< 4 , �.; ,r;. :. 4�wx.• `. �., c� energy,residential
y 1 � �,�,}.. y � at (with above sq.R) 75.00 2
A((l(�`. ..� (rj11r ,`�1 f t t'I.U/U 1 1 S -1 0 {�V' �� Limited energy,multi-family 75.00 2
{V e 20 U) 0 0 n O 1 1 residual(with above sq.R.)
Va `V is '.4'.2'... .-..'''''t
`s" !s ,, P f:: ',+ . t ,.'"` Renewable Enter Q Page 2
' z.; „' , „�„. + " ,. t., ,` - ° "' - a Services or feeders ioshlladontalteraf on,and/or relocation
Name: N1 D 11.v\, f�, ((ttViLL���'o W 200 amps or less _ 100.70 2
+_` 201 amps to 400 amps 133.56 2
Address: l Z gj`7iZ SW 1?�!>(d A� 2 401 amps to 600 amps 200.34 2
City/State/ZIP: �I C Q WI, p q` 1 Z t% 601 amps to 1,000 amps 301.04 2
Phone:(e ) 005 yjq 11 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary Email: A 4\M O 810 O w A11. OW- relocation services or feeders installation,alteration,atttUor
Owner tallation:This inllation is deing made on property that I own which is not 200 amps or less 59.36 t
intended for sale,lease,rent, t exchanle, r •Mg to ORS 447,449,670, d 701. 201 amps to 400 snaps 125.08 2
Owner signature`-' , r� � Date �/..4 401 amps to 599 snaps 168.54 2
.r Branch circuits-new,alteralo!,or extension,per panel
n:4 L"fi> r.21; ??'k';*, ,� ' K "�_''r .� s r. - ..a-. :` A.Fee for branch circuits with
Business name: IF above service or feeder fee, 1 7.42 2
each brands circuit
Contact name: B.Fee for branch circuits whhoar
service or feeder fee,fist 56.18 2
Address: branch circuit
City/State/ZIP: Each add`I 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
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 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:( ) I Fax:( ) Investigation(I hrmin) 90.00/hr
Industrial plant(t ter min) 78.18/hr
Email: Inspections for which no fee is
90.00/ter
CCB Lie.: Electrical Lic.: I Suprv.Lic.: specifically listed 'A ter mix
= 1,. FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit b not obtained within NO
Print name: Date: days after it boa been accepted as complete.
• Number of inspections allowed per permit
:tBuildinglPamitatEl.C_PernvlApp_ELaERE.doe Rev 06/172015 440461ST(11/05/COM/WEB