Permit CITY OF TIGARD ELECTRICAL PERMIT
$ COMMUNITY DEVELOPMENT Permit#: ELC2020-00293
13125 SW Hall Blvd..Tigard OR 97223 503.718.2439 Date Issued: 06/11/2020
Tf[;ARI3 9 Parcel: 1S134DB13600
Jurisdiction: Tigard
Site address: 11194 SW 114TH PL
Project: Brightwood,Lot 8 Subdivision: BRIGHTWOOD SUBDIVISION Lot: 8
Project Description: Adding(1)branch circuit for installation of NC unit.
Contractor: GARNER ELECTRIC Owner:
2920 SE BROOKWOOD AVE A
HILLSBORO,OR 97123
PHONE: 503-648-4552 PHONE:
FAX: 503-642-7925
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 06/10/2020 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 06/10/2020 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 w r Urea ou to follow the rules dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 9 001 090. Y may obtain a py of th ales or direct questions to OUNC by calling 503.232 87 or 1.800.332.2344.
Issued By: /t/ i Pe-imittee Signature: eV.
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.
RECEIVED
Electrical Permit Application JUN 4 t FOR OFFICE USE ONLY
City of Tigard
�` IN ��G6�U��l2�j
IIIl gi 13125 SW Hall Blvd.,Tigard,OR 97223 BUIL'�'U Plan Review Pen i /�
I Phone: 503.71 S 2439 Fax: 503.598.1960 Date/By ,e i�'r/ -oo:3SL
Inspection Line: 503.639.4175 Ready DareBy: Iota: El See Page 2 for
TLGAK D Internet www.tigard-er,n_ov Nm i tied/Method: Supplemental I nturana lion
TYPE OF WORK •'"PLAN_REYIEW .
Vfl‘lew construction ❑ Add Iion/alteration/replacement please cheek all that apply(suhmi12 sets of plans wiitcoR checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available limit current ❑Tlarims and boatyards.
.:- . ..CN1 c9,RY OF CONSTRUCCION. exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to gourd,or exceeds 14,000 0 Couunercai-use agricultural
k 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps atoll 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
- ❑Addition of new motor load of system.
Job#: 1110 - Job site address: IHg4 SW 11444i P., 100HPormore. ❑"A'"E" "l-'-",^i-3
occupancy.
❑Six or more residential units. ❑o Recreational vehicle parka.
City/S[ate/Z,IPf T'��'� ❑Health-cam facilities- ❑Supply i voltage For more Is.
Suite/bldg./apt.#: Project name: ❑Hazardous 10ea11011S Sup colts lnag Ior
han
['Service or feeder G00 amps or more.
inal,
Cross street/directions to job site: .:'FEE'•SCHEDULE
DaefotMr I Qtr. J Earl I Tonal I
p, New residential single-or multi-family dwelling unit.
F.l
Subdivision: bfrn, {M0 Lot#: le) Includes attached garage.
1.000 Sc,R.or less 16554 4
Tax map/parcel#: Ea..add'I 500 sq.fl-or ponion 33.92
' "DESCRIPTION OF WORK Limited enery',residential 75,00 2
Alt, I N c-rP0 Cr ) cru -9 ire.*it (with above sq;11.)
1 Limited energy,multi-family 75.00
residential(with above sq.ft.)
. o Renewable Energy ❑ See Page 2
XI'ROPERTY OWNER I ; El TENANT '`R Services or feeders installation,alteration,and/or relocation
Name: S LONE '? 4 P&B I10 Mes NW 200 amps or less 100,70 a_
Address: gz3�0 L* WOOP Sr. SUITE 100 201 amps to 400 amps 133-56 '-t
p��t -.�r 401 amps to 600 amps 00,34
City/State/ZIP: L.#ieeorojeho OR.• g7035 601 amps to 1.000 amps 301.04 2
Phone:(�3)3 7+ern Fax:(57DD 3 e7--7(015 Over 1,000 amps or volts 552.26 2
v�� � Temporary services or feeders installation,alteration,and/or
Email: 0106 DMBNYA COATI relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.01 2
Owner signature:
Date: 401 amps to 599 amps 168.54 2
- -- Branch circuits—tam alteration,or extension,per panel
AEI.APPLICANT 0 CONTACT PERSON - A.Fee farina*circuits with
Business name: S7o NE gnu H µW above service or feeder fee. 7.42 2
.}� each branch circuit
*
Contact name: IT 4P42� TT B.Fee for branch circuits without
service or feeder fee,first I 56.1 N 2
Address: branch circuit
Each odd'I branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84
dwelling,service and/or feeder
Email: Reconnect only 67.54 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: V^s"l4 ' I i-rg l G Sign or outline lighting 67.84 2
Z. LO �� �� panel, lteraiionorimlcnaienergy 0 See Paige 2 '-
Address: panel,alteration.or extension.
CItY 1 {I i l3V .Afn 97 +2-3 Each additional inspection over allowable in any of the above
/State/ZIP: �� 1 Additional inspection(1 hr mitt) 6625/hr
Phone:(9 3) 0• ill (',fQ3) ?i. Investigation(1 hr min) 90.00/hr
Industrial plant(I hr min) 78.t$. hr
Email: Inspect jars for which no fee is
/r,T- specifically listed(!4 lir min) 90.001 hr
CCB Lic.: 121'�j�l Electrical Lic.:34' e 30
.;.A/ /� � ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: 37b7tS' - Subtotal:
Print name: CH pas &A• 4.113L Dale: 6•1.7ro ❑Plan Review Require!(25%ol'pcmil ice):
State surcharge(12%of pormit lee):
TOTAL PERMIT FEE:
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Dam: days after II has been accepted as complete.
* Number of inspections allowed per permit
t,\6ai1diny4YnnieOELC rermilApp_ELR_ERE.dae Rev 06/172015 J444415TI 1103 CUM,WEO
1
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
neuripl ion I Or), 1 Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less wo 70
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:
El Burglar Alarm 25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva ss2z6 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
eating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
0 Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable is anv of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr Irvin)
Inspections for which no be is 90.00/hr
spec;flea llyr listed(t4 iir s.in)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 •
Subtotal(Enter on rage 1):
' Number irapcoions 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
D HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
0 Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
Iaaoildinelrennib'ELC_PnmirApp_CLR_ERE.doc Rcr Wr.I7.2015