Permit CITY OF TIGARD ELECTRICAL PERMIT
® COMMUNITY DEVELOPMENT Permit#: ELC2020-00441
Date Issued: 8/31/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S102CD01400
Jurisdiction: Tigard
Site address: 13565 SW ASH AVE
Project: Goulet Subdivision: FREWING'S ORCHARD TRACTS Lot: 16
Project Description: Add (1)200 amp panel for future accessory building.
Contractor: OWNER Owner: GOULET, LAURA M & GERALD T
13565 SW ASH AVE
TIGARD, OR 97223
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 08/31/2020 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 08/31/2020 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 Alt 952- 0090. 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: Permittee Signature: !JA7
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.
RECEIVE It
Electrical Permit Application Fort 0171 10E I SE ONLY
City of Tigard AUG 2 4 2020 �' t
Rsccived �7 /�7
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review , Perron n �G / {, v o �/
Phone: 503.718.2439 Fax: 503.598.1960 iTY Or IIG�IRD jJgpp/gy; Related Pemdt#:
1 A
Inspection fine: 503.639.4175 t UILDING DIVISION Ready Date/By: lure El See Paget for
T'GARP
Internet: wunv.tigard-oGgov Notified/Method: Supplemental Information
4
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 0 Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION _.- . exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-foully dwelling D 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: 0 Fire pump. 0 Installation of ISO KVA or
JOB SITE INFORMATION AND LOCATION LL ._- :-..;1-''...:,....P.',- ❑emergencysystem- larger separately derived
#: Job site address: - - - - ,('*N ❑Addition of new motor load of system
Job
A address: 1,.1. J.II` 7(,t -Y.s IZA a _..._ tOOBP or more. ❑..A..,B...,,_2..,.,_3..
City/State/ZIP: 'r ❑Six or more residential units. occupancy.
1 _ [O ��''jj-7 ❑Recreational vehicle parks.
�Gt � ..,. _,L-,(..„ - ❑Health-care facilities.
Suite/bid apt.#: "" j Project name: G«t�7 } ❑Hazardous locations. ❑Supply voltage far more than
-__�..�t ..-_. fir.. 600 volts nominal.
❑Service or feeder 600 amps or more
Cross street/directions to job site: taa�a ._ ��Th A P'E t iesgD ` "
_.___ -........_.._�_ r.... " 1 III`=-.1 .. ,., -:` ;.
Descrtpnon I qtr. I gam r Total i •
..__........,.. .............__.... _...._......_....._ New residential single-or multi-family dwelling unit.
Subdivis of i Lot#: Includes attached garage.
_.. _._.. _.... _—_- .. _..-._.... r
I,000 sq ft.or less 168.54 i 4
Lax lnap-parcel G. ---_. __ --- - .._.-.
___ ...__.___ _______ Ea.add'l 500 sq.ft.or ponies 33.92 1
DESCRIPTION OF WORK _. Limited energy,residential
r- 75.00 2
.y ` N. I --- (with above sq.ft.)( i�t" C!. r _'t_ `0, ;._ 1' �i - t AC-C..", .^,..c,t .. ,a Limited energy,multi family
residential with above sl.ft.l 75.00 2 Y
-- - - - - .rv-•-.-- •- --- Renewable Energy 0 See.Page 2
ffly5t! PROPERTY OWNER I0 TENANT I
..-----se3t. y t_ -- _ Services or feeders iastallation,allerafion,endlOr rdocadoq
Name:.... rt \..C\ _ Y...k,.L\_rL T77.. . ..__.. ._...____ 200 amps or less I 100.70 I( .7B 2
a
Address: ` m' r., . -y. ate, , _ 201 amps to 400 amps 133,56 2
rt
I --- 401 amps to 600 amps 200.34 2
City/State/ZIP. { 1_a" r d- -0� [_j 7 Zz3 _ 601 amps to 1,000 amps 301.04 2{
!!!
Phone:( ) tr -' 11tt��"_ Fax W
:( ) Over 1,000 amps or volts 552.26 2
�. _......_ ......_ _.___.__
Temporary services or feeders installation,alteration,and/or
Email: .iT e C. , a 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, rid 7)I. 201 amps to 400 amps 125.08 2
Owner signature.; .g�. Date: , D Z� L) 401 amps to 599 amps 168.54 2
❑ APPLICANT
' + +^r-w- Branch circuits-new,alteration,or extension,r er Panel' �._,....___ m �. ' ,.; .s s + t =c A.Fee for branch circuits witA
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: serviceci feeder fee,fast 56.18 2
branchh circuit
City/State/ZIP: Each add'l branch circuit 7.42 --- 2
Miacellaneoos_(;aervice,ar feeder not included)
Phone:( ) I Fax::( ) Each manufactured or modular
-......_. ........._..-_._..--.-.._..__-.._._ 67.84 2
Email: d 'limit,service and/or feeder M
Reconnect only 67.84 2
r =l'^- '14 -zff4` Pump or irrigation circle 67.84 2 I
Business name: Sign or outline lighting 67.84 2
Signal circuits)or limited-energy ❑ See Pa e 2 2
Address_ -.s._�m-__.._-.-.--_ _® _ _ PaneLalEemtio¢.orezteosion g
City/State/ZIP: Each additional ittapeetio¢over allowable is any of the above
....... .._..._--------- ___,„--"-..-.-...___-._--._ _.._.__._ Additional inspection(I br min) 6625/hr
Phone:( ) Fax:( ) .._ . Investi:ation I br man) 90.00/hr —
Email: Industrial dant I hr min) 78.18/hr
__ ....._.�.-...,. ._.. .__._..,...._. _.... ,- Inspections for which no fee is .
CCB Lie.: Electrical Lic.. Suprv.Lie.: s ecificallt listed i%hr mint 90.00/hr
: ELECTRICAL PERMIT FEES I.
Suprv.Electrician signature,required: Subtotal I( ';, _!
I Print name: "..__ Date: ❑Plan Review Required(25%of permit fee):
State surcharge @2%of permit fee): IL c
TOTAL PERMIT FEE: �12_, j l �
Authorized signature:
This permit application expires if a permit la not obtained within ISO
I Print name: j Date: days after It has been accepted as complete.
l, • Number of inspections allowed per permit.
I9Building1Permiu'ELC_PermaApp ELR ERE.doc Rev 06/17J2015 440-4615T(11/O1COMIWEB