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Permit CITY OF TIGARD ELECTRICAL PERMIT `1 1 2 `'• COMMUNITY DEVELOPMENT Permit#: ELC2020-00554 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/15/2020 g f Lea\R. g Parcel: 2S109DB09100 Jurisdiction: Tigard Site address: 13058 SW BLACK WALNUT ST Project: McPherson Subdivision: SUMMIT RIDGE NO.5 Lot: 159 Project Description: (2)branch circuits for exterior outlets for radiant heaters. Contractor: OWNER Owner: MCPHERSON, AMBER M &LEE 13058 SW BLACK WALNUT ST TIGARD, OR 97224 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 2 crt Branch Circuits wo/Purchase 11/06/2020 $63.60 Specifics: Service or Feeder 1 ea 12%State Surcharge- 11/06/2020 $7.63 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $71.23 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 requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through,OA,R�95522-001-0�0099�0. You� ,m(a'yyoobt�ain/naa copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: W6 `ubIt01)*L) Permittee Signature: On (SYl 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. RECEIVED :- ,I ylzo Electrical Permit Application FOR OFFICE USE ONLY wUU 4 2020 DutdI5e,l i �/ 4f) CityoJ'Tigard Date/By: Ili Pe,mdrE(.L2.02.4)._©v,Ssy It • 13125 SW Hail Blvd.,T . 2 C TIGARD Plait Rcvicw I, s Phone: 503.718.2439 �1j.5r 78 Id 1 Date/By: Related Permit q: Inspection Line: 503.63 iy�IN G DIVISION Ready Date/By: //_�/ / AIM: S Page 2 fur I L1.1 t� Internet: www.tigard-or.gov Notified/Method:'TU. ZC, I ® ec pl Su demenlal Information TYPE OF WORK EJ`1*i l.— LEE PLAN REVIEW 0 New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 400 snips or more 0 Building over three stories. ❑Demolition ❑Other where the available Mull current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 111,000 amps at 1511 volts or 0 Floating buildings. 'iI-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less mground,or exceeds 14,000 ❑c'ummeroial-use agricultural amps for all other installations. buildings. 0 Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived �❑Addition of new motor load of system. Job#: I Job site address: ISO S$ '(,J �C k ` �p J, I OOHP or noon.(Nosh yl ❑..A....F....1_2....1_3.. City/State/ZIP: �/ A(� O oc ❑Six or more residential units. occupancy. `/� / ��� I ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: I Project name: 0 Hazardous locations. 0 Supply voltage for none than ❑Service or finder 600 amps or more. 600 volts nominal, Cross street/directions to job site: ) 'I FEE SCHEDULE • tiro r(u-f 1't.&4 L PA- Pjia ,I_- j,�iA,(91mvi//v itp k_VI tie New residential I intQ,Yi I Each ( total I ! single-or multi-family dwelling unit. Subdivision: I Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.aeld'I 500 sq.II.or portion 33.92 1 �f DESCRIPTIONI OF WORKWORK ..1y., Limited energy,residential t o� dl� I2 tcL CIr(�,vt.S �\0 Q/�(1S1' yUQ,� (with above sq.li.) 75.W 2 ii � 1 i c^ -1 t� Limited energy,multi-family 75.00 2 `11/1V taikk80( ()(AA k S -;' moat,( Vu2AAt(S. residential(with above sq.IL) PROPERTY OWNER I ❑ TENANT Renewable Enrgy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation Name: I�e� tAc p f Sgy�. 200 amps or less 100.70 2 Address: 1 30 S S_ 'g,A k U k),.hut 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/Stale/ZIP: \d,P �lct 0 9i-aaI 601 ampslo 1,000 amps 301.04 2 ^-o�iJ� I Phone:(Sjo')) - 1 2.;s Fax:( ) Over 1,0(0 amps or volts 552.26 2 2�tsk Temporary services or feeders installation,alteration,and/or Email: L\" Se+'� e� 1(y,O�p'�r`, CQyr� 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,o�e� xch§rage,a rding to ORS 447,449,670,r an 701 201 amps to 400 amps 125.118 2 Owner signature: rent, /� Date[ 1 o 46 10 401 amps to 599 amps 168.54 2 ®'APPLICANT I CONTACT PERSON Branch circuits—new,alteration,or ex tension,per panel A.Fee for branch circuits with Business name: N/A above service or feeder tee, 7.42 2 QJ � each branch circuit Contact name: Lee krA (z`,,,sm.-. B.Fee for branch circuits without service or feeder tee,float I 56.18 9b.vk0 2 Address: )3 o 58 50 d ! (xxLIe ( J".l yL4 S'r- branch circuit City/State/ZIP: (, sock O(Z a iaa `I Each add'I branch circuit I 7.42 -.4-I2- 2 G� rJ / Miscellaneous(service or feeder not included) Phone:(N rj) "}D$ — (2 S S I Fax::( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Lee_ {v(c26.14-Sa.,, @ i-sti-}rrtp,ti. '.e- ` Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: © hi!J Ems.. Sign or outline lighting 67.84 2 Signal circuitls)or limited-energy Address: panel,alteration,or extension. CISee Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(I hr min) 66.25/hr Phone:( ) I Fax:( ) Investigation(I hr min) 90.00/hr Email: Industrial plant(I hr min) 78.18/hr Inspections for which no fee is 90,00/hr CCB Lic.: I Electrical Lic.: ] Suprv.Lic.: specifically listed 04 hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: 63•( O Print name: Date: 0 Plan Review Required(25%of permit fee): A/ State surcharge(12%of permit fcc): 9. 1p3 Authorized signature: T( � TOTAL PERMIT FEE: 2. , A �/ / This permit application expires if a permit is not obtained within ISO Print name: f---�� iv(G ph S py� Date: l 1f/L0 days after It has been accepted as complete. // * Number orinspeclinns allowed per permit. I:\Rsiklin/\Pennnx\ELC PermitApp_ELR ERE.doe Rev 06/172015 440-4615T(I l/05COM/WEn • Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Deeartgbn I QtY. I Laub I Total I • Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: s kva or less 100.70 2 5.01 to 15 kva 133.56 2 0 Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >I W kva(fee in accordance with OAR 915-309-0040) 552.26 2 ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva-no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr charged at an hourly(I hr min) Inspections for which no fee is 90.00/hr specifically listed(V.hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page I): (SEE OAR 9 1 8-309-0000) Number of inspections allowed per permit. Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ 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 tor all other installations I:\Ruilding\Permin\ELC_PermitApp ELR ERE.doc Rev06/17/2015