Permit CITY OF TIGARD ELECTRICAL PERMIT
°; _ COMMUNITY DEVELOPMENT Permit#: ELC2O20-00269
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/01/2020
T I i,;A li T) 9 Parcel: 1S126DC03002
Jurisdiction: Tigard
Site address: 9250 SW LEHMANN ST
Project: Perry Subdivision: LEHMANN ACRE TRACT Lot: 8
Project Description: Adding(12)branch circuits for bedroom&bathroom.
Contractor: ROBERTS ELECTRIC INC Owner: PERRY, STEPHEN W
5759 SW 48TH ST 9860 SW 92ND AVE
PORTLAND, OR 97221 TIGARD, OR 97223
PHONE: 503-244-7754
PHONE: 503-451-1115
FAX: 503-244-0560
FEES
Quantity Description Date Amount
12 crt Branch Circuits wo/Purchase 06/01/2020 $137.80
Specifics: Service or Feeder
1 ea 12%State Surcharge- 06/01/2020 $16.54
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $154.34
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 pe mit will expir if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires ou to Blow the es opted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 95 -0090 u may o n a cop the s or direct questions to OUNC by calling 503.232 7 or 1.800.332.2344.344
Issued By: S Permittee Signature: e:;;(/ //)
.
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 Application FOR OFFICE USE 0\1.1
r RECEIVEI •-
City of Tigard Date/B : ( APIPIjir".4. - II
• 13125 SW Hall Blvd.,Tigard,OR 97223 MAY 2 0 202C Plan Review
g Phone: 503.718.2439 Fax: 503.598.1960 Date/B :
Inspection Line: 503.639.4175 CITY
Y O Ready Date/By: j See Page 2 for
ricnito FTIGARD
Internet: www.ti ardor. ov otified/Method: Supplemental Information
g g BUILD'J�lG DIVISI
PE OF WORK PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
El Demo ion ❑Other: ['Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ['Emergency system. larger separately derived
C/�2J t 0 Addition of new motor load of system.
Job#: Job site address:
"1C W 1..) S Le vul/fyJ 100HP or more. ❑"A","E" "1-2""1-3"
City/State/ZIP.----� lZ .� 0 Six or more residential units. occupancy.
s c S(1.--R�� Z�'S ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: µv n J c) �,� 0 Hazardous locations. 0 Supply voltage for more than
�4'.-� 1 600 volts nominal.
❑Scrvicc or feeder 600 amps or mom.
Cross street/directions to job site: Q, ,�, �.�-�,_ FEE SCHEDULE
Description I Qty. 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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
t• ' o i > (l C� � 4 (with above sq. 75.00 2
: Limited energy,multi-family 75.00 2
2�. - -Z.. l residential(with above sq.ft.)
J 47 �--3 Renewable Energy 0 See Page 2
PROPERTY OWNER. 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: \,�,�,� k.._� 200 amps or less 100.70 2
�7 '� ...,I S ��r� _ 201 amps to 400 amps 133.56 2
Address: —1 0`,p.C� l-,.) t Ls•-� 401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:(SW,) - 1\ L S Fax:( 5.—{j'� Over 1,000 amps or volts 552.26 2
Email: ('Z'-5`-[ e,/>- v -- �(� tl AAst ,- t`�� Temporary services or feeders installation,alteration,and/orrelocation
Owner installation:This installation is being ma a on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchangers cording to ORS 447,449,670,aqd 70 201 amps to 400 amps 125.08 2
Owner signature: N.- — Date: S 1 T L5 401 amps to 599 amps 168.54 2
'Nib / Branch circuits-new,alteration,or extension, .er panel
APPLICANT 0 CONTACT PERSON
A.Fee for branch circuits with
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name: C�,, 6a�vs._.,-62,___ B.Fee for branch circuits without
service or feeder fee,first t
Address: branch circuit 56.18 �.15
/2
City/State/ZIP: Each add'l branch circuit 1 I 7.42 2
Miscellaneous(service or feeder not included)
Phone: ( ) Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: _ _ _ Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 2x,L e S '7�QrG"4'1-- ` r� Sign or outline fighting 67.84 2
Address: �� Signal circuit(s)or limited-energy
�-1 S 9 c� ��� panel,alteration,or extension. ❑ See Page 2 2
C . Each additional inspection over allowable in any of the above
City/State/ZIP
�i72.n Lf�e�-t't4 U� -Z3 Additional inspection(1 hr min) 66.25/hr
Phone:(Sj-t!) -2_4 4 - -"4 is..- Fax:( ) Investigation(I hr min) 90.00/hr
tcS'
Email: l� t� 1 Industrial plant(1 hr min) 78.18/hr
_I 3l ,1 r4twram, e-t.t/V�,,,4+ , L0�% Inspections for which no fee is
CCB Lic.:P 9 3 FF Electrical Lic.:ml W./�' (a 3 SUprv.Lie.' specifically listed(%hr min) 90.00/hr
Suprv.Electriatf Siff drci ) uired: / f VZ 1- ELECTRICAL PERMIT FEES
Subtotal:
~ 0 / Plan Review Required 25%of permit
Print name: "�� {\f� �q�M e te: 5/g �W 0 eq ( P fee):
JJJ State surcharge(1.2%of permit fee):
Authorized signatur . ��, A� TOTAL PERMIT FEE:
This s permit application expires if a permit is not obtained within 180
Print name: 1��_..+ �+y o_it_la--.-‘ Date: Q5 i !_,� days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:1BuildinePermitslELC_PermitApp_ELR ERE.doc Rev 06/17/2015 15'7(1105/COM/WEB