Permit CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT Permit#: ELC2020-00579
Date Issued: 11/18/2020
T f C,A R p 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S103CD06100
Jurisdiction: Tigard
Site address: 11710 SW FAIRVIEW LN
Project: Subdivision: TERRACE TRAILS Lot: 21
Project Description: Changing main panels,new ground rods,rewire bath lights,new wash/dry circ.
Contractor: GRESHAM ELECTRIC
Owner: LEE, GREGORY D
4664 SE ANTELOPE HILLS DR LEE,VIRGINIA L
GRESHAM, OR 97080 14 LANDS END LN
SEQUIM,WA 98382
PHONE:
PHONE: 503-810-8140
FAX: 503-667-9374
FEES
Quantity Description Date Amount
• 1 ea Services or Feeders-200 11/18/2020 $100.70
Specifics: amps or less
10 crt Branch Circuits w/Purchase 11/18/2020 $74.20
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 11/18/2020 $20.99
Electrical
Type of Const:
Occupancy Grp:
Total $195.89
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.
Issued By: 1/1—CA3k Gk V - wr <-7._ Permittee Signature: dh CPPIIt—CI.KIDP‘
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 Applicati il ECE rile ter l It£ t 'I I,•i
City of Tigard Pao"� /�® Pemnitr^" 1
ille 13125 SW Hall Blvd.,Tigard,OR 97223n(�II 1 Edo Review -minis#: C>'O rJ
Z Phone: 503.718.2439 Fax: 503.548.198({O V 8 2020 Dar Related Permit if:
l t c n it a Inspection Line: 503.639.4175 C ITV O F TI Ia AR D Ready Datelly: RI See Page 2 for
Internet: www.tigard-or.gov Noti6ed/Me hed: Supplemental Information
TYPE OF WORK DIVISInN
PLAN REVIEW
❑New construction p Addition/alteration/replacement Please check all that apply(submit j sets of plans w/itmns checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Dem011titm ❑Other.
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or O Floating buildings.
gI-and 2-family dwelling 0 CommercialTndustrial 0 Accessory building less to grams,or exceeds 14,000 0 Commercial-use agricultural
❑Multi-family El Master builder 0 Other site for all other instellatiotrs buildings.
raga
❑Fre puma Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION . 0 Emergency system. larger separately derived
address: !_ + O Addition Mom motor load of system
Sob#: fob site i/7/47 Jc4t i r?�J�id -N 4.'4 mote or more. O_1+_,"E••...1_2,•,"i-3".
City/$tatelZlP: �� O Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ❑Aaaardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross s(reet/directions to job site: FEE SCHEDULE
Description I Qty. 1 End i Total I •
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(with above sq.it.)
e--./•J-rl-..![cue" M,1-.0 r./ .>4x/t`G 4/i740 . c'.iI) 0CDP-5 Limited energy,multi-family
REW/i2 E /j9- Z.!L7a7$ nN� ov4sra U'y c-t'�t Renewable Energy above I residential(with ft.) q ge2 2 75.
0 PROPERTY OWNER 1 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps nr less / 100.70 /y+p Jl 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:
601 amps to LOW amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
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 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
0 APPLICANT I 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee fir branch circuits with
Business name: above service or feeder fee, 1�y
each branch circuit / 7.42 1,.7"' 2
Contact name: B.Fee for branch circuits' without
Address: service a feeder fee,OM56.1s 2
brands circuit
City/State/ZIP: Bich add'I branch circuit 7.42 2
Phone: Mi cellaaeous(service or feeder hot included)
( ) Fax ( ) Each manufactured or modular
Email' dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: C.r-''�.� G�La /) ��&� it- ,e1A./e- Sign or outline lighting 67.84 2
Address: r /��� / /.r�� Signal circuit(a)or limited-energy 0 See Page 2 2
`y`�+IV T CS�l7NJ�wp£ 4/ ere Panel,alteration,or extension.
City/State/ZIP: 4 Each additional inspection over allowable in any of the above
Ems* / j 7 Additional inspection(1 hr min) 66.25/hr
Phone:(S71, 0—Ay 4 0 I Fax:(S c ) 66 7 37 m7L Investigation(1 hr min) 90.00/hr
InchistriEina l: /f-S/�t3'7 F'f „_ t lG - C-D h'J ai plum(h ter min) 78.181 hr
)oapcuiaas for which no fee is
CCB Lic.Z9tis 3 Electrical Lic.: 7 0/34/ suprv.Lic.:i 1 f{L�fS specifically listed r;,lu min) 90.001 hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required' ��� Subtotal: t 7/, Y
Print name: / / Q_ 4 --7� 0 Date/0_21 '2c 0 Plan Review Required(25%of permit fee):
/ State surcharge(12%of permit fee): ZCj3
Authorized signature: TOTAL PERMIT FEE: /9/.ors
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:lauilding1PermitslELC_PermitApp ELR ERP.doe Rev 06/1712015 440-4615T(I l/05/COMIWEa