Permit 114 CITY OF TIGARD ELECTRICAL PERMIT
a COMMUNITY DEVELOPMENT Permit#: ELC2020-00531
T I G AR ID 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/26/2020
Parcel: 2S111AD05500
Jurisdiction: Tigard
Site address: 8750 SW PINEBROOK ST
Project: Smith Subdivision: PINEBROOK TERRACE Lot: 78
Project Description: (7)branch circuits for addition.
Contractor: OWNER Owner: SMITH, NICHOLAS I
8750 SW PINEBROOK ST
TIGARD, OR 97224
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
7 crt Branch Circuits wo/Purchase 10/26/2020 $100.70
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/26/2020 $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 OAR 952-001-0090. You may obtain as copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: `1`�V 0 '\t 'c Permittee Signature: on aver�t fh V'1
,�.JI Oy� (C
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 Applicatioi (_' FOR OFFICE USE ONLY
CI O Tigard
�rll V Received y/ Permtg 1 ' �y
`J g Date/BY: Io J/f7 � � �4VG SJ—W SLr
E
13125 SW Hall Blvd„Tigard,OR 97223 7 yy q Plan Review
_ Phone: 503.718.2439 Fax: 503.598.19600C I Y J CO20 Date/By Related Penult M � �1-_0 "
Inspection Line: 503 639 4175 (� OF Ready Date/By: Juris Fa See Page 2 for
T WARD Internet www.tigard-or.gov t�"ff'� 'Ifss'.!!r` TIGARDy# Notified/Method Supplemental Information
=-11-Y13E`O W 1NQ j rsr - pia 3431l0'' '�- , ; .
❑New construction E Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked).
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
- -_ CATLGORY O O'\STRLCTION ',; rill exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 I-and 2-family dwelling ❑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 150 KVA or
- t JOB SITE 3111'P..� N AND LOCATION ❑Emergency system larger separately derived
0 Addition of new motor load of system.
Job 4: Job site address:8750 SW Pinebrook Street I00HP or more. ❑"A","E","I-2","1-3",
❑Six or more residential units. occupancy.
City/State/ZIP: Tigard OR 97224 ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: Hall to pinebrook
FEE>5 �3
Description I Qty. Each I Total •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft or less 168.54 4
Tax map/parcel 4: Fa.add'I 500 sq ft.or portion 33.92 1
:'DESCRIPTION OF WORK Limited energy,residential
75.00 2
(with above sq.ft.)
Additional Circuits for permitted addition Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
B PROPFRTV OWNER E 'I"ANT Services or feeders installation,alteration,and/or relocation
Name: Nick Smith 200 amps or less 100.70 2
Address: 8750 SW Pinebrook Street 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Tigard OR 97224 601 amps to 1,000 amps 301.04 2
Phone:( 503 ) 310-3439 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: nick.psu@gmail.com 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,lea ent,o exFh�ncording to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: �� Date: 10/13/2020 401 amps to 599 amps 168.54 2
•• - --- Branch circuits-new,alteration,or extension,per panel
❑-APPLICANT' I '❑ CONTACT' -x A.Fee for branch circuits with
Business name: NON E above service or feeder fee, 7 42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first 1 56 18 .�c--y f®2
Address: branch circuit f0 I
City/State/ZIP: Each add'I branch circuit 6 7.42 h y!, );),‘ 2
. Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
- -- dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR - Pump or irrigation circle 67.84 2
Business name: NONE Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 see Page 2 2
Address: panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax: ( ) Investigation(I hr min) 90.00/hr
Industrial plant(I hr min) 78.18/hr
Email: Inspections for which no fcc is 90.00, hr
CCB Lic.: Electrical Lie.: Suprv.Lie.: s ecifca6 listed I'/hr mini
,-=1- ,17,,i LLECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: /iJ[) , i;
Print name: Date: 0 Plan Review Required(25%of permit fee): --
State surcharge(12%of permit fee): !d -U�
TOTAL PERMIT FEE:r//a 7.
Authorized signature:
�rf t. . v This permit applicationexpires if a permit is not obtained within 180
Print name: Date: 10/13/2020 dayssaftereritt has been accepted ass complete.
a Number of inspections allowed per permit.
l:`3luildingV'ermits'ELC PermitApp_ELR_ERE.doc Rev 06/17/2015 440'4615T(1 l/05/COM/WEB
• Branden Taggart
elCity of Tigard
s Senior Permit Technician
Community Development
13125 SW Hall Blvd
Tigard, OR 97223
(503}718-2449
brandent@tigard-or,goy
From: Nick Smith<nick.psu(cagmail.com>
Sent:Tuesday, October 13, 2020 11:56 AM
To:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: Nick smith mechanical and electrical apps
Caution'This message was sent from outside your organization.
Attached are my mechanical and electrical permits. The furnace was just replaced in may and I am now just adding
ducking that was planned for. That work will be performed by advanced heating.
I will be doing my own electrical work.
Thank you!
Nick Smith
2