Permit CITY OF TIGARD ELECTRICAL PERMIT
d1 I COMMUNITY DEVELOPMENT Permit#: ELC2020-00561
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/12/2020
Parcel: 2S103BC01700
Jurisdiction: Tigard
Site address: 12905 SW 121ST AVE
Project: Armas Subdivision: CANOGA PARK Lot: 1
Project Description: 200 amp temporary service on south side of dwelling for fire repair.
Contractor: OWNER Owner: ARMAS,JANET
22383 SW LEE DR
SHERWOOD, OR 97140
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
Specifics: 1 ea Temp Services or Feeders- 11/11/2020 $59.36
200 amps or less
1 ea 12%State Surcharge- 11/11/2020 $7.12
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $66.48
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.
�✓ ✓J �G/C %7Niv/
'�3- O
Issued By: �.--�`'� �-•"�� L{ Permittee Signature:
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 ApplicarioECEIVED FOR OFFICE USE ONLY'City of Tigard Received
Date/By: ////0/2-0 4 0 Permit It .,20 O—OCS( /
11 • 13125 SW Hall Blvd.,Tigard,OR 973,jhti b
2020 Plan Review s
■ Phone: 503.718.2439 Fax: 503.598.1ft/6d Date/By: Related Pemtit#:
Inspection Line: 503.639.4175 /�+1 f3 Ready Dated3y: urn• ® See Page 2 for
TIGARD Internet: www.ti and-or. ov CITY 1 Q� A � Notified/Method:�/ �� ?� `�a
y g g Supplemental Information
TYPINORK' DiViSiON ls'Y19-7r I- L 9'-- PLANREVIEW
❑New construction K 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 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
X I-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.
❑ Multi-family 0 Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address: a 5 l s Aye, ❑Addition of new motor load of system.
I OOHP or more. ❑"A" "E" "I-2" "t-3"
( ,p ❑Six or more residential units. occupancy.
City/State/ZIP:
t 5cte�J rike qt 7 a a3 4"/`� 4-c ❑Health-care facilities. ❑Recreational vehicle pasts.
Suite/bldg./apt.#: Project name: r 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: 5 W AlL g'Pr T4 FEE SCHEDULE
Description I Qty. I Each I Total I ,
`7 New residential single-or multi-family dwelling unit.
Subdivision: Lot#: I G 0 0 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
s ' r (with above sq.ft.) 75.00 2
I )l k I `ri A1®111 A S-k So tiv+A 5/0 e Limited energy,multi-family
0 F /_I f e, o t, S ey rt 1 { �r,,La `_ t S;de
e, j,,—Kr722 residential(with above sq.ft.) 75.00 2
1 I I G rp T L a /� Renewable Energy ❑ See Page 2
1,PROPERTY OWNER ❑ TENANT
{/ZO Services or feeders installation,alteration,and/or relocation
Name: 14 i I rr a Anna a 5 f+Q aA tic, i ill /.` 41/ t 200 amps or less 100.70 2
Address: 1 CI 5 S Liss) l A,15 �AI V e ,fl n 201 amps to 400 amps 133.56 2
I�YJ;' r 401 amps to 600 amps 200.34 2
City/State/ZIP: .+- et` or 7 ?....2., 3 601 amps to 1,000 amps 301.04 2
Phone:() G g 0.3 9 i 05 Fax:( ) Over 1,000 amps or volts 552.26 2
( Temporary services or feeders installation,alteration,and/or
Email: WI a 4 -f IA Kr n G.( J® (/VIA,i 1 , Ir o m relocation
Owner installation:This installation is being maet6 on property that I own which is not 200 amps or less / 59.36 1 17
intended for sale,lease,rent, r exchange,c{ n� �� according�� tf to ORS 447,449,670,apd 01. 201 amps to 400 amps 125.08 2
Owner signature: t •! J.4'WW�. Date: 1. 1 v Ol v 401 amps to 599 amps 168.54 2
❑ APPLICANT ❑ 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 without '
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 7A2 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
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: panel,alteration,or extension. g
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) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lie.: Suprv.Lic.: specifically listed('/hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: s q, 3
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): bP—
Authorized signature: TOTAL PERMIT FEE: ID y
This permit application expires if a permit is not obtain within 80
Print name: - Date: days after it has been accepted as complete.
' Number of inspections allowed per permit.
1:\Building\Permits\ELC_PemiltApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(I1/05/COMIWEB