Permit Support Document CITY OF TIGARD ELECTRICAL PERMIT
II Is •
COMMUNITY DEVELOPMENT Permit#: ELC2020-00432
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
• ,11/ Date Issued: 9/3/2020
9 2q Parcel: 2S103DA05700
Jurisdiction: Tigard
Site address: 10634 SW COOK LN
Project: Sholes Subdivision: FANTASY HILL Lot: 11
Project Description: To get inspection for work done w/o permit for bathroom conversion.09/29/20: Reprinted to add contractor
Contractor: R& D ELECTRIC INC Owner: SHOLES, LANCE M & KRISTIN A
PO BOX 868 106334 SW COOK LN
MULINO, OR 97042 TIGARD, OR 97223
PHONE:
PHONE: 503-679-7987
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 09/03/2020 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/03/2020 $7.63
Type of Use: SF Electrical
Class of Work: ALT 45 Misc Administration Fee 09/29/2020 $45.00
Type of Const:
Occupancy Grp:
Total $116.23
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 require you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-00 ou y obt ' a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: U/ri 4°RiCATAJ
OWNER INSTALLATION ONLY
The Installation Is being made on roperty 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
Electrical Permit Application FOR OFFICE USE ONI.1.
•
'� City of Tigard S E P 2 9 2020 Da eReceBsa Permit ` O FY�(•�
• 13125 SW Hall Blvd.,Tigard.OR 97223 Plan Re „ 6/ �t��
= Phone: 503.718.2439 Fax: 503598.1960CiTY OF1 R3ARD a, j V Related Permit'z:
'i1Gg1iD Inspection Line: 503.639.4175 BUILDING DIVISIO "y tea,;' y: ,nrir HI See Page 2 for
Internet: www,tigard-or.gov .L;,/! r Supplemental Information
TYPE OF WORK "' , I°� PLAN REVIEW
❑New construction i,Addition/alteration/replacement l. Please checkaltthatappg(submitzsetsofplans„hems checked):
v( 0 Senlce or feeder 400 amps or more 0 Building over three stones
❑ Demolition ❑Other: %%here the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
•
I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground.or exceeds 14.000 0 Commercial-use agricultural
amps for all other installations. buildings.
Multi-family 0 Master builder ❑Other: 0 Fire pump 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system larger separately derived
,� ` ❑Addition sinew motor load of system.
Job#: I Job site address:l o SW �te 100HP or fore. ❑••A'."E'•."1-2'."I-3
City/State/ZIP: V �� q�a�3 0 Six or more residential units. occupancy'.Recreational
a / ❑Health-care facilities. 0 Recreational vehicle{marks
Suite/bldg,/apt.#: v f Project name: 0 Hazardous locations 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: I`ya,N�•!'�S Ave. , FEE SCHEDULE
l ��" v pyedptloe I Qts. I Each I Taint I '
New residential single-or multi-family dwelling unit.
Subdivision: y' 1-6-1it I Lot»: Includes attached garage.
1.000 sq ft or less - 168.54 4
Tax map/parcel Ea.add"'500 sq.ft or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Limited energy.multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
PROPERTY OWNER 7 I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name. -.. j-) ! / .n_ce. �1n/ems 200 amps or less 100.70 2
Address: 1 H/ 3 if' Y• `-'^'/tW k 201 amps to 400 amps 133.56 2
V f0 W 401 amps to 600 amps 200.34 2
City/Slate/ZIP: �/V (2)-2. . 9'7 3 601 amps to 1.000 amps 301.04 2
Phone:' £'_'3,D6 '�I Fax:( ) Over 1,000 amps or volts 552.26 2
1 �,,� ,rrnn �J`L �� Temporary n services or feeders installation,alteration,and/or
Email: J.».6- LA.r.6 j/ h drib L. 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 08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
0 APPLICANT I ❑ CONTACT PERSON Branch circuits-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 udrltore
service or feeder fee.first 2
Address: branch circuit 56.18 �• . leg
City/State/ZIP: Each add'I branch circuit I 7.42 1-7,Ta 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84
Email: dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR , Pump or irrigation circle 67.84 2
Business name: l? 1, " /o n�..'�J Sign or outline lighune 67.84 2
��..��1.�21.�r v Signal circuit(s)or limited-energy
Address: ! 3 30 S /b /�7 �� ❑ See Page 2
panel.alteration,or extension.
City/State/ZIP: 0 reR /11y�) . q 17,2a �j Each additional inspection over allowable in any'of the above
�,/ LAC • / J Additional inspection(I hr mm ) 66.25/hr
Phone: n'�I 7q{r{ Fax:( ) Investigation I I hr min) 90.00/hr
Email: _/Cl�(J ,r Industrial plant(I hr min) 78.18/hr
N hC)v GL 1 o ( '". Inspections for which no fee is 90 00/hr
CCB L.ic.i', 'f4 Electrical Lic,:C_ 3`A, Suprv, Lie.:g'25y,s specifically listed(Y hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature, required: Subtotal:
Print name: PRO 0�/� A ,0`r�.ri Da e:1_aq ZU7��j ❑Plan Rev iew Required(25%of permit fee):
` ` ` I I+ 'q State surcharge(12%of permit fee):
s Authorized signature: \ -G - ` ,\ -.j �1 ~\ TOTAL PERMIT FEE: "71 a3
I` This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I auildingTermits:Elf.Permh App.I'.I.R ERE due Res 0v17._01g 440-0I ill I 1 S CO'FWEa
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Descriplion I Qlv. I Each I Tolnl I •
Fee for all residential systems combined: S75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 00 70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* is a: to25 kva 200,34 2
Kind generation systems in excess of 25 kva:
❑ Burglar Alarm 2501 to 50 kva 30104 2
50.01 to 100 IA 552.26 2
n Garage Door Opener* 0o kva(l2e in accordance
a ith OAR 918-309-0040) 552.26 2
❑ Heating. Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva Dyer 25 7.42 3
❑ Vacuum Systems* >100 kca—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Each additional inspection is
Other: 6625/hr
chareed at an hoods(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(v,hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I):
$75.U0
Fee for each commercial system: • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
rl Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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