Permit CITY OF TIGARD ELECTRICAL PERMIT
• ',' ' COMMUNITY DEVELOPMENT Permit#: ELC2020-00471
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/8/2020
T I C�A IL TD g Parcel: 2S103AC01401
Jurisdiction: Tigard
Site address: 11227 SW FONNER ST
Project: Drummond Subdivision: None Lot: None
Project Description: Reconnect only.
Contractor: OWNER Owner: DRUMMOND, DUSTIN &YULIA V
PO BOX 11701
ZEPHYR COVE, NV 89448
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 10/04/2020 $67.84
Specifics:
1 ea 12%State Surcharge- 10/04/2020 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232,1987 or 1.800.332.2344.
01
Issued By: W Permittee Signature: 1 �o l 1 S
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 Applicati0 ECEIVE® I(nt t,l I if l: I 'sr. u.i.,
City o Tigard 2' R`:me('a Pem„tn a e
f g �FP 2 2 20�. Data'liv: �y 20 40 a zc .20._00 f ,7I
, ` 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
' = Phone: 503.718.2439 CITY OF TIGARD Date/By: Related Permitl:
Email: TigardBuildingPermits@Tigard-px,gtw , „ Ready Date/By: kris: ID See Page 2 for
TIGARD Inspection Line; 503.639.4175 Internet: www.tigard-or.g N Notified/Method: Supplemental information
�j TYPE OF WORK " '�(`: ,-.,. PLAN REVIEW
New construction r Addition/alteration/replacement Other:
Please check all that apply(submitjsetsofplansre/items checked):
0 Service or feeder 400 amps or more ❑BUJ Id:ng over three stories.
❑ Demolition ❑ where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION
, exceeds 10,000 amps at 150 volts or floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
I-and 2-family dwelling ❑Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family ❑ Master builder QOther: ❑Fire pump. ❑Installation of l50KVA or
JOB SITE INFORMATION AND LOCATION ' ❑Emergencysystem. larger separately derived
,. Addition of new motor load of system.
)oh#: dobsiteaddress:;. L122'] Sk) coNAitiR- S7, loom'nrmoe.
p� �j occupancy.( C ity State/ZIP: : c.� L V f o� 1?223 ❑Six or more residential units
El
Recreational vehicle parks.
❑Health-care facilities.
0 Hazardous locations.
0 Supply voltage for more than
Suite/bldg.lapt.#: Project name: 600 volts nominal.
0 Service or feeder 600 amps or more.
Cross street/directions to job site: SW I I S` A lt� FEE SCHEDULE gij
Description I qty. I Each I Tool I • S
New residential single-or multi-family dwelling unit. I
Subdivision: Lot#: Includes attached garage. I
1,0Tax map/parcel#: 2,. S I 03 A C O I. O CI Ea..a dd'1 sq.5 or less 168.54 4
F 500 sq ft.or portion 33.92 1
'';II -.', :-: 4-•„,,.po„r„„-z.. .. ..-*s1�.3„g, Limited energy,residential 75.00 2
� '' ✓✓i!!`e�Az ILAL- '1 C6Nevf,L! " (with above sq.ft.)
jl/W t I` Limited energy,muhi-fatuity 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
r .P*-45 ,. 4- E+It;2;a' r.: - 0 TENANT, - 'l Services or feeders installation,alteration,and/or relocation
Name: "---)u�j ,.a -'--Dt &, v 9 200 amps or less 100.70 2
q A"' J n` /� 201 amps to 400 amps l 33.56 2
Address: 27 28 A,,,,,-DtAce j (JU 4 - lee.
401 amps to 600 amps 200.34 2
City/State/ZIP: -1AL,is-..7 f Cn(L q7 S4-a 601 amps to 1,000 amps 301.04 2
Phone: ( 5,1i5) &33 i -�W�S Over 1,000 amps or volts 552.26 2
/� Temporary services or feeders installation,alteration,and/or
Email: Ous-TtiJ C Yo )A SI„JIN► , CC?•44'1 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,according to ORS 447,449,67///0,,land 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: f
'�"-- 9/1_2/Z,a 401 amps to 599 amps 168.54 2
0 CONTACT PERSON ";,"``' Branch circuits-new,alteration,or extension,per panel
�srk'L�. - I �� '`°"' A.Fee for branch circuits with I
Business name: above service or feeder fee, 7.42 2
_ each branch circuit
—�Contact name: /us-rt.-4 ��tvvttp .j V B.Fee for branch circuits without
v �- /J Q service or feeder fee,first
Address: `�'7"'LgJ �C� � .Sa (,.
J -!'" �o• branch circuit 56.18 2
Each add'1 branch circuit 7.42 , 2
City/State/ZIP: �qG�� v((-_ 17 5�r7
Miscellaneous(service or feeder not included)
Phone:(8- ) co 31 uJ 1-� Each manufactured or modular 67.84 2
(� c dwelling,service and/or feeder
Email: u u -r, e� - vo OA-V 1"J v -co AN Reconnect only I 67.84 2
CONTRACTOR' ' , f' , zr--b: Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy Page 2 2
Address: panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: Additional inspection(I hr min) 66.25/hr
Phone:( ) Investigation(1 hr min) 90.00/hr
\ Industrial plant(I hr min) 78.18/hr Email: Inspections for which no fee is
CCB Lie.: Electrical Lic.: Suprv.Lic.: specifically listed(Yes hr min) 90 00/hr
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
/� /, State surcharge(12%of permit fee):
Authorized signature \ 1- _ r— — TOTAL PERMIT FEE: 7S:CJ�
��'-^� �J_ .tea This permit application expires If a permit is not obtained within l80
tP.rint name: Vv ST-I^I )--7(1-t7N1"cIe/C"'� nitz> days after it has been accepted as complete.
`,• 7✓ " Number of inspections allowed per permit.
i.Building,Permits\ELC. PamitApp_ELR,Fab doe Rev 10/26/2017 440-4615T(I I/05/COM/WEB