Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2020-00194
Date Issued: 04/14/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135CA00201
Jurisdiction: Tigard
Site address: 11025 SW 95TH AVE
Project: FEDERAL NATIONAL MORTGAGE Subdivision: MEADOW VIEW Lot: 6
Project Description: Reconnect only.
Contractor: Owner: FEDERAL NATIONAL MORTGAGE ASSN
5600 GRANITE PKWY
PLANO, TX 75024
PHONE: PHONE: 503-709-3547
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 04/13/2020 $67.84
Specifics: 1 ea 12%State Surcharge- 04/13/2020 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 O 952-001-0090. u may obtain opy of the rules or direct questions to OUNC by calling 503.23 or 1.800.332.2344.
Issued By: Permittee Signature:
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.
D.
DocuSign Envelope ID:DD252210-88FA-44B8-8FCC-0761038E04C0
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received el6/g%�C) >i Pemut#&e �.6,_ai7 j
III • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
!/ �7/t
0 Phone: 503.7182439 Fax: 503.598.1960 Date/By: Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Saris: El See Page 2 for
TIGARD Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW _,
❑New construction ❑E ddition alteratio electric m nt
Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more ❑Building over three stories.
El Demolition Other: Reconnect electric meter 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 ❑Commercial-use agricultural
1-and 2-family dwelling 0 Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi-family D Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
O Addition of new motor load of system.
Job#: Job site address:11025 SW 95th Ave I00HP or more. ❑"A',`E "t-z",`t-3",
O Six or more residential units. occupancy.
City/State/ZIP: Tigard,OR 97223 0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: El Hazardous locations. 0 Supply voltage for more than 0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: 95th&SW Anna Bell Ct FEE SCHEDULE
Description I Qty. 1 Rack 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#: R0273938 Ea.add'I 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(with above sq.ft.)
Reconnect electrical meter permit/inspection
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
❑ PROPERTY OWNER I ❑ TENANT
Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address: 200.34 2
401 amps to 600 amps
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 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 signatu Date: 401 amps to 599 amps 168.54 2
Branch circuits—new,alteration,or extension,Per panel
Vit APPLICANT CONTACT PERSON A.Fee for branch circuits with
Business name: eXp Realty above service or feeder fee, 7.42 2
each branch circuit
Contact name: Jenny Mengis B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 503 )709-3547 Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Jmengis@gmail.com 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(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: Inspections for which no fee is
90.00/hr
d('/c hr min)l listed
se
CCB Lie.: Electrical Lic.: Suprv.Lic.: specificallyELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
Authorized signature: T"'e
D.e,.ab„ed bl. 'u State surcharge(12%of permit fee):
illitA
0
aD2n8269D4234AC 4/13/2020 TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Jenny Meng s Date: 4/13/2020 days after it bas been accepted as complete.
• Number of inspections allowed per permit.
Id➢wilding\Permits\ELC_PemnIApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
DocuSign Envelope ID: DD252210-88FA-44B8-8FCC-0761038E04C0
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. I Each I Total
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
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:
4g Other: Electrical meter reconnect Each additional inspection is 66.25/hr 1
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page l):
Fee for each commercial system: $75.00 • Number of nspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
IT 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
t\BuildingTmnits'ELC_PttmitApp_ELR_ERE.doc Rev 06/17/2015