Permit Support Document (2) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT w Permit#: ELC2020-00347
T 1 G A.PD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/9/2020
Parcel 2S104AA90091
Jurisdiction: Tigard
Site address: 12662 SW KAREN ST 9
Project: 29828 Subdivision: BELLWOOD TERRACE CONDO Lot: 9
Project Description: Crkt for gas fireplace lighting in kitchen. 8/4/2020: REPRINT permit to add(1)branch circuit for microwave.
Contractor: BOONES FERRY ELECTRIC INC Owner: BELLWOOD TERRACE LLC
PO BOX 628 PO BOX 189
WILSONVILLE, OR 97070 YAMHILL, OR 97148
PHONE:
PHONE: 503-682-4936
FAX: 503-682-7946
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 07/09/2020 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 07/09/2020 $7.63
Type of Use: COM Electrical
Class of Work: ALT 1 crt Branch Circuits w/Purchase 08/04/2020 $7.42
Service or Feeder
Type of Const: 0 ea 12%State Surcharge- 08/04/2020 $0.89
Occupancy Grp: Electrical
Total $79.54
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 throu�y�'AR 9 -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.
3 ///5
Issued By�Vr t 7i3t.(tee(/1—; Permittee Signature: aA/ r971/A4--/ C4--17e/v/
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 JUL 2 7 2020 FOR OFFICE USE ONLY
City of d Ti Receives
Tigard OF TIGARD Hate/By: r —��-c✓ •t' Permit": ELC2020-00347
It n 13125 SW Hall Blvd.,Tigard,OR. 97223 t Plan Review
a ' Phone: 503.718.2439 Fax: 503.598:7 _DING. DIVISIO!'' DatdBy: Related Permit It:
" Inspection Line: 503.639.4175 Ready Date/By: ram: ® See Page 2 for
TIGARD Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK- 'PLAN REVIEW
❑New construction lgj Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRITCTTON exceeds 10,000 amps at 150 Volts or 0 Floating buildings.
❑ 1-and 2-family dwelling 0 Commercial/industrial IDAccessory building less to ground or exceeds 14,000 ❑Commercial-use eg cultural
amps for all other installations. buildings.
®Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑rmergencysystcm. larger separately derived
❑Addition of new motor load of system
Job#: 29931 Job site address: 12662 SW Karen#9 10011P or more. ❑"A "E "1-2", la
City/State/ZIP: Tigard ❑Six or more residential units. occupancy.
9 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Bellwood Terrace 0 Hazardous locations. ❑Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts marital.
Cross street/directions to job site: FEE SCHEDULE
Ueacrpdao I Qty. I.. ..Earl, 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'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.} 75.00 2
Adding Crkt for Microwave ls•�tiJ( Per -tl�
Limited energy,multi-family 75.00 2
C L ,2-CI L/ft L) _. ,/ 7 residential(with above sq.ft.)
El PROPERTY OWNER _, 0 TENANT Renew ❑ See 2
Services orable E feednergyers installation,alteration,Page and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
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 5936 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: Date: 401 amps to 599 amps 168.54 2
❑ APPLICANT ❑ CONTACT PERSON Branch circuits-c new,alteration,or extension,per panel
-- --- - A.Fee for branch circuits with
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 1 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: Boones Ferry Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: PO Box 628 panel,alteration,or extension.
city/state/ZIP: Wilsonville OR 97070 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:(503 ) 682-4936 Fax:( 503) 682-7946 Investigation(I hr min) 90.00/lir
Email: keith@boonesferryelectric.com Industrial plant(I hr mm ) 78.18/hr
Inspections for which no fee is 90,00/hr
CCB Lic.: 88482 Electrical Lie.: 3- 3C Suprv.Lie.: 4918S specifically listed CA hr min)
Et,FCTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print.name: Stan Herron , Date: 7/27/20 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): F.r y
Authorized signature: TOTAL PERMIT FEE: �7 . Il
This permit application expires if a permit Is not obtained within 180
Print name: Date: days after it has been accepted as complete.
e Number of inspections allowed per permit
I:lBuadis\Ps mit\ELC PenailApp ELR_ERE.doe Rev 06/17/2015 440-46157(1 I/05/COM/WEB