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Permit 71 CITY OF TIGARD ELECTRICAL PERMIT "- H COMMUNITY DEVELOPMENT Permit#: ELC2020-00427 Date Issued: 8/21/2020 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S103BB06500 Jurisdiction: Tigard Site address: 12195 SW 121 ST AVE Project: Wolf Subdivision: None Lot: None Project Description: (2)branch circuits for new shed dormer above garage. Contractor: OWNER Owner: RABAU, MARLA S WOLF, KEITH S 12140 SW KATHERINE ST TIGARD, OR 97223 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 2 crt Branch Circuits wo/Purchase 08/21/2020 $63.60 Specifics: Service or Feeder 1 ea 12%State Surcharge- 08/21/2020 $7.63 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $71.23 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 OAR 952.00Q90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: ! .� '.• 2,"y �?' ,t✓-' Permittee Signature: �.i >/ � l% �-�fl f/'7C-"i„;' 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 `'3 ECEIVE 1- I 1 FIt(ii I it I I "I t I�I ) . City of Tigard • t ' f- 2e& 2v <VC) Permit 1<:6-��1 --Q 0 Lf,2 7 s 13125 SW Hall Blvd.,Tigard,OR 97223 A U G 17 q p Dan R Phone: 503.718.2439 Fax: 503.598.1960 2 0C.G Plan Review Date1B Related Permit t: l l v.t h P. Inspection line: 503.639.4175 CITY OF TIGARD Ready DateBy. ,uric 65 Sec Page 2 for Internet: www.tigard-or.gov ' !'l nit.r c ,i Notified/Method: supplemental Irdbrmatton TYPE OF WORK PLAN REVIEW 0 New construction 4ddition/afteration/replacement Please check all that apply(submit/sets of plans w/items checked): 0 Demolition ❑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 0 Commercial/industrial Et Accessory building ❑Multi-family Itss to ground or exceeds14,000 ❑Commercial-use agr;<uumal (((/ — El Master builder ❑Other; amps for all other installations. ❑Fire buildings. PAP ❑Installation of 150 KV A or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address / .r ❑Addition of new motor load of system. 12 1 (S S 1,..) /2./ 100HP or more. ❑"A","E","1-2","1-3„ City/State/ZIP: ❑Six or more residential units. occupancy. ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt#: Project name: ❑Hazardous locations. ❑Supply voltage for more than 0 Service or feeder 600 amps or more. 600 wits nominal. Cross street/directions to job site: 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'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limitedenergy,residential 5�/j �j/ (with above sq.ft.) 75.00 2 ""'�'' z,is tg--1 a Limited ene rgy,multi-family 75.00 2 residential(with above sq.ft.) EiRenewable Energy ❑ See Page 2 PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: /a/T"K w ae. F 200 amps or less 100.70 2 Address: /2 / 9 1- 5 tr.) /.2 / s r v 201 amps to aoo amps 133.56 2 — 401 amps to 600 amps 200.34 2 City/State/ZIP: 776,412_b © K . 97a. 2 601 amps to 1,000 amps 301.04 2 Phone:(5-o3) S!D 3'26,,© ' Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: c4Jo/roila n r s.5 5 ( C e, a s F. A/e j-- 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, rdi RS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: ��` �j Date: 5 /s.^,?Qpj' 401 amps to 599 amps 168.54 2 Branch circuits—new,alteration,or extension, lerpanel 0 APPLICANT , ❑ CONTACT PERSON A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit eontacl name: B.Fee for branch circuits without Address: service or feeder fee,first / 56.18 2 branch circuit City/Stale/ZIP: Each add'!branch circuit / 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax::( ) Each manufactured or modular 67.84 2 Email: dwelling,service and/or feeder 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 Address: panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: Each additional inspection over allowable In any of the above Additional inspection(1 hr rain) 66.25/hr Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lie.: specifically listed(V,hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal. (v;3 .ccG) Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): -2, (✓ Authorized signature: TOTAL PERMIT FEE: /., 1 This permit application expires If a permit is not obtained within 180 Print name: Date: days after it has been accepted y as complete. • Number of inspections allowed per permit. I:tau;IdingtermiIs\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 4404615T(t I/05/COM/WEB 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 1 Total I • Fee for ill residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.702 5.01 to 15 kva 13355 2 O 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 Ices 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance with OAR918-309-004 552.26 2 0) ❑ 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 an of the above: ❑ Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(Yi hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): y • Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls 0 Clock Systems ❑ Data Telecommunication Installation ❑ Fire Mann Installation ❑ HVAC ❑ Instrumentation Intercom and Paging Systems ❑ Landscape Irrigation Control* El 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 1:43wlding\Pennhs\II.0 PemtitAPP_ELR ERE.dor Rev 06/17/2015