Permit CITY OF TIGARD ELECTRICAL PERMIT
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lsep p COMMUNITY DEVELOPMENT Permit#: ELC2020-00418
Date Issued: 8/27/2020
TIGARD 13125 SW Flail Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S102CD01100
Jurisdiction: Tigard
Site address: 9515 SW EDGEWOOD ST
Project: Grigg Subdivision: EDGEWOOD Lot: 17
Project Description: Upgrade(1)320/400 amp panel.
Contractor: OWNER Owner: GRIGG, STACEY
9515 SW EDGEWOOD ST
TIGARD, OR 97223
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-201 to 08/19/2020 $133.56
Specifics: 400 amps
1 ea 12%State Surcharge- 08/19/2020 $16.03
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $149.59
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 952 001 9,90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued By: ��,,. ' i �Z'�- l <✓f Permittee Signature: �/V I�,�1 G'7 �� ��C'/\J
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 RECEIVES l uk O 1 lCI L SE 0VI.1
City of Tigard q�!G Derma a IS Ze1 dPermit /
• 13125 SW Hall Blvd.,Tigard,OR 97223 0 6 2 02�1 plan Rev ew 0 t'
=' phone- 503.718.2439 Fax: 503.598.19 DateJB : RelatedPermit4:
acITV OF TIGARD
Inspection Line: 503.639.4175 ReadyDate/By: turn: WI See Page 2 for
fIG,�KD Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: SupplementalInformatIon
TYPE OF WORK PLAN REVIEW
0 New construction Addition/alteration/replacement 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.
❑Demolition El Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-Family ❑Master builder ❑Other: ❑Fre pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ['Emergency system larger separately derived
Job#: Job site address: J y� ❑Addition of new motor bad of system.
�5/5"-ScA�" t.�f/f+'+E-1.(,0.Cj.6 51- 1001IP or more. ❑••A,,,•,E" ••t-2„ "I-3,•
City/State/ZIP:+�j/_ i,g,) b,2 c ^-7 z ❑Six or more residential units. occupancy.
l 1r�itl� _ "' ` 1 I ` � � ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: 1 Project name: PANT V 0 Hazardous locations. 0 SupSupplylvots nogefor
1 more than
0 Service or feeder 600 amps or more.
Cross street/directions to job site: EDGF 0/� FEE SCHEDULE
Description I Qtr. I Each I Totel I
New residential single-or multi-family dwelling unit.
Subdivision: a GE t� Lot#: Includes attached garage.
1,Tax map/parcel#: �((6 uO Orr d(6 E .a d sq.5ft or less 168.54 4
YY'' t� fir Ea.addl. sq.ft.or portion 33.92 1
//+� DESCRIPTION OF WORK /�' ' Limited energy,residential
UP CO.. t NC bl� 0 V 21-O4(& i CO 4 ) $EnkGc rE e L (with ne ge sq.multi
75.00 2
``' i Limited energy,multi-family 75.00 2
1—() ✓�� �t 0 f0 el T residential(with above sq.ft.)
PROPER OWNERRenewable Energy 0 See Page 2
TENANT' Services or feeders installation,alteration,and/or relocation
Name: e.S Tk&I '(—i6,4 200 amps or less 100.70 2
Address: R5(5 Sty FDGI-L614cD 20lampsto400amps 133.56 �3j j7, 2
.�; 401 amps to 600 amps 200.34 2
,
City/State/ZIP: I t0 1 ,a t -72-2-3 60t amps to 1,000 amps 301.04 2
Phone:(53 ) 1 L7"(4�7 Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Sit Ce�/] � �S3 V ie' �r(( M Temporary services or feeders installation,alteration,and/or
. � � relocation
Owner installation:Th4S installation is be made on pr erty that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent, ch . g t RS 447,449,670,rrand 01. 201 amps to 400 amps 125.08 2
Owner signature: Date: I,S�� 401 amps to 599 amps 168.54 2
AP IC� CONTACT PERSON Branch circuits—new,alteration,or extension per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
`A�/��T each branch circuit 7.42 2
Contact name: 12 1 V ( B.Fee for branch circuits without
Address: service or feeder fee,fast 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 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: Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00i hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed(Y hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrici ignature,required: Subtotal: /33,56
Print n . Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 1(p r05
TOTAL PERMIT FEE: ` et
Y�
Authorized signature:
This permit application expires if a permit is not obt$in d isi.thinet180
Print name: C.-rA e� 4(2.16, Date: 3/5I days after it has been accepted as complete.
v `'"�1 • Number of inspections allowed per permit.
I:1Buildeg Torras\ELC_PeradtApp EL _ERE.doc Rev 06/17/2015 440-46151DI/05/COM/WEB