Permit (2) CITY OF TIGARD ELECTRICAL PERMIT
°'! n- tl COMMUNITY DEVELOPMENT Permit#: ELC2020-00348
Date Issued: 7/29/2020
TIGARD 13125 SW Hat Blvd.,Tigard OR 97223 503.718.2439 parcel: 1S134CA00535
Jurisdiction: Tigard
Site address: 11040 SW 119TH AVE
Project: Platt Subdivision: PANORAMA NO.2 Lot: 26
Project Description: (2)200 amp service panels/feeders for house and future garage and(6)branch circuits.
Contractor: OWNER Owner: PLATT, SCOTT D &JODI L
11040 SW 119TH AVE
TIGARD, OR 97223
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Services or Feeders-200 07/13/2020 $201.40
Specifics: amps or less
6 crt Branch Circuits w/Purchase 07/13/2020 $44.52
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 07/13/2020 $29.51
Electrical
Type of Const:
Occupancy Grp:
Total $275.43
Required Items and Reports(Conditions)
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•
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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 OOAAR/Q57-001-0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
l'Ll.,51
Issued By: �( �/'>' (/CR:/.X�"' Permittee Signature: ✓�� �/.3 L C %7C)",
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 Appl ca ran,.NJ a. a v 1... r;. 11)R U F I ICI 1 I NI (iN i 't�.�,.I /� ,( /�
City Of TIgBI'd. IIIIII s Received
7�O/'jam .�� Paarit L�s-V lit/ oo J�/3
J 13125 SW Ball Blvd.,Tigard,OR 97223'N t 5 2020 plan Review/ /
Phone: 503.718.2439 Fax: 50 59$19t><) Date/By: Remud Permit#:
Inspection Line: 503.639.4175 '/
Tiir.NiD f> .. 1 Ready Date/BY: u3: $See Page2far
u : Internet www.tigard-or.gov : Notified/Method: I Supplemental Information
I TYPE OF WORK .. "its ; "T . `' 91 ^, PLAN REVIEW ..''''''',:,fix---:--,-:,'
El New construction N. m Addition/al Please check all that apply(submit I sets of plans wfltetos checke ):
CIService or feeder 400 amps or more ElBuilding over three stories.
❑Demolition [3 Other:
where the available felt crmem 0 Marinas and boatyards.
'OTEGORY OF"CONSTRUCTION exceeds 10,000 amps at ISO volts or ❑Floating buildings.
EL1-and -family dwelling ❑Commercial/industrial ❑Accessary building
loss to ground,or exceeds 14,000 ❑Commercial-use agru:uarmal
[_]Multi-family D Master builder El Other: Fops other installations. buildings.
Fire puump.mp. 0 Installation of 150 K V A or
JOB SITE INFORMATION AND LOCATLON ❑ParrersencY system. larger separately derived
0 Addition of new motor load of system.
Job 4: Job site address: ( I0'40 . .I ilrti-i""C-Ve-.,. I00HPormore. ❑RA"."E,"1-2","1-3
City/State/ZIP: rl t f (�(Z r� ❑Sixormoreresidentialwrim. occupancy.
.1 a 1 ��"? El Health-carefacilities. ❑Recreation El al vehicle parks.
Suite/bldg apt.#: Project name: ^,/ ,' ,4. ✓. S( Lftle., ❑Hazardous locations. ❑Supply voltage for more than
( _e tt7ce4,s 0 Service or feeder G00 amps or more 600 volts rrurra nol.
Cross street/directions to job site: f\lci�t?..„,„,;.4.--0,„ f5,f- 4 i(�F FEE S DULE
eecriPave I Ore. 1 Ewt I -"tacit I x
New residential single-or multi-family dwelling unit.
Subdivision: Peas i O t-t",,.w,_ ,, .6 '2.- Lot ii: ,..,40 Includes attached garage.
T.enap/parcel d: ( 1,000 sq.ft.or less 168.544
.-U c,5 3 S Ea..add'1500 sq.ft or portion 33.92 1
DESCRIPTION OF WORK 5f,_ Limited energy,residential 75.00 2
yt;nr PC5- - c.`.:-v-16)i{:As rc.`e"...0 X./' re'r.G C.�-m-�E.^C'.,- (with above sq.ft:)
q Limited energy,multi-family
Far t-4 ' 1111 t- c,'e� >A a t•-t P 5 1.`e- '_!,,1..,4.` ' _ residential(with above sq.ft) 75.00 2
TY OW15ER`, 0,TENANT Renewable Energy 0 See Paget
Services or feeders installation,alteration,and/or relocation
Name: "&c -r f Pi.-.A. 'f" 200 amps or less 3. 100.70 2
Address: (l(3`�-0 S tnJ I, r+,-t
t cY /42 . Zot amps to 410 amps I� 13s.56 z
f 401 amps to 600 amps Ao- 200.34 2
City/State/ZiP: T'I, o,..i. d. C5/2-^ � 7 2;1...3 601 amps to 1,0t)0 amps fs 301.04 2
Phone:('sp)i 7 Za- 01-7 3 Fax:( ) Over 1,000 amps or volts i j:/ 552.26 2
Temporary services or feeders installation,alteration,and/or
Email; .S'/J PLAt( ) A.A.SAf . C-Cs MA relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 l
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: (a l'14-/7.:7 401 ampsto 599 amps 168.54 2
. '-, •- Branch circuits-new,alteration,or extension,per panel
❑ APPf.ICAi9T ,;,� 0 CONTACT PERSON ,, A,Fee for branch ciauits with •
Business name: • above service or feeder fee, 6 7.42 2
`1 each branch circuit
Contact name: (� At/te /"49-j,/� /./OA/ it.S B.Fee for branch circuits withaw
� service or feeder fee,First
Address:
. 0 FD2, frz, 7ztie-+— 4tJ- branch circuit 56.18 2
City/StatefZIP: /47#.44,—, • Each add'I branch circuit 7.42 2
Fax: Miscellaneous(service or feeder not Included)
Phone:
( ) ( ) Each manufactured or modular
Email: .dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
* ° ; :,''.14.irti Pump or irrigation circle 67.84 2
Business name: d(✓(/ A/ Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy ❑ See Page 2 2
pastel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP:
Additional inspection(lhrmin) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: • Industrial plant(1 hr min) 7&18/hr
Inspections for which no fee is
CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed CAhr min) 90 hr
FEES„
Fk
Suprv.Electrician signature,required: •.$ ELECTRICAL PERMIT
Subtotal 3°i4,fa=
Print name: Date: El Plan Review Required(25%of permit fee): ,$/
State surcharge(12%of permit fee): 'y'? '
Authorized signature: TOTAL PERMIT FEE: �{tg-; —
This permit application expires if a petmais not obtained within 180
Print name: Date: days after it has been accepted as complete. "t'75,, i f 3
' Number of inspections allowed per permit. O
Ilauilding\Permits\ELC YwmerApp ELaERE.doe Rev 06117/2015 440.0615T(11/OSICOM/WEn