Permit CITY OF TIGARD ELECTRICAL PERMIT
2 p COMMUNITY DEVELOPMENT Permit#: ELC2020-00639
Date Issued: 12/18/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S109AD00900
Jurisdiction: Tigard
Site address: 12705 SW BULL MOUNTAIN RD
Project: WATSON Subdivision: None Lot: None
Project Description: Reconnect only.
Contractor: Owner: WATSON FAMILY TRUST
598 CREEKSIDE DR SE
SALEM, OR 97306
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 12/18/2020 $67.84
Specifics:
1 ea 12%State Surcharge- 12/18/2020 $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 O, R 952-001-0 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: �" ,��12"Lef�al4 Permittee Signature: %v/ /7t:✓ e-`51-7--70
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.
RECEIVE L
Electrical Permit Application -C 1 4 2020 iron orrl(h. 1'SE ONLY
City of Tigard Received13 : e r ,2 WI . • P,A
• 13125 SW Hall BIvd.,Tigard,OR 97223 ;V OF TIGARD Plan Review
-
Phone: 503.718,2439 Fax: 503.598.1960 Dard6 : Maud Permit ter
DING DIVISIOf�I
TIGARD Inspection Line: 503,639,4175 Ready Date/By: % See Page t for
Internee wvwv.tigard-or.gov Nodl1ed/Meibpd: 4; ,., jrriainill Seppleneeral Information
TYPE OF WORK Cit.e_ZF-'Leal "91i'rel PLAN REVIEW
❑New construction ❑Addition/alteration/replacement Please cheek�ji that apply(submitl,sets of plans wlitems checked):
0 Service or feeder 400 amps or more 0 Building over three notics.
Q Demolition ,'Other: where Me available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or 0 Floating buildings.
.. 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building loss to ground or exceeds 14,000 ❑Corn re MI-use agrkuhumi
ings.
❑Multi-family ❑Master builder ❑OtherFiresom for aiFier installations. Insbuitallation
0Fire pump. 0 Installation of ISO KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. brae':separately derived
Job site address: ❑Addition of new motor load of system.
Job#:
kZ�0$- 7J T?IA.II fv r. F.p loouFormore. ❑•A. E, t-z 1.3
City/State/ZIP: '(L sej,f4 f> (AI-'z Li ❑Sixter mare facidrnu. unite. • ❑��final vehick parks.
/ ❑tkalrhKare Ikeiatks.
Suite/bldg/apt.#: I Project name: ❑Huaidoaslocations. Q Supply solcage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross strcctldircclions to job site: FEE SCHEDULE•
5� w�l >�>" Deariptior. I ore. 1 rank 1 ma •
1N t c) . New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.B.or less 168.54 4
Ea add'l 500 sq.ft.or portion 33.92 1
Q ! DESCRIPTION- S OF WORK 1 '',,• Limited energy,residential
40 .4 �j �W` S- eS -- /MI6( `s-a 4 (with above sq.R.) 75.00 2
F- D ��'"�• Limited energy,multi-family 75.E 2
�'1 E W D`a"\v 1.4 0. R.f a s fete I W' residential(with nave sq.B.)
( Renewable Energy 0 See Page 2
PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: tit Vdev,4rak 200 amps or less 100.70 2
S�t�s (_Yg f �.51 C 201 amps t0 400 amps 133.56 2
Address: ��
( 40l amps for 600 amps 200.34 2
.w-
City/State/ZIP: 6o'. C 6 j3D1(O 601 amps lo1.000turps 301.04 2
Phone:(5 S3) g (.15.%,3 7si1 p Far:(5- ) ?At-`l4 b Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: Al L (P en...A i),E. LeM relocation
Owner instal Lion: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 to400 amps 125.08 2
Owner signature: Dale: 401 amps to 599 snips 168.54 2
0 APPLICANT I .Ci.CONTACT.PERSON Branch circuits-new,alteration,or estension, ,er panel
A.Fee for branch circuits with
Business name: Z,t/v15 above service or feeder fee- 7.42 2
.�;' each branch circuit
Contact name: �4��j p� la 4 A Nc B.Fee for branch circuits wrtlr0m
Address: 1 service or feeder fee,first 56.18 2
?o e(i)C 12"�1.t ,,..55 branch circuit
City/State/ZIP: cCy,(4 c.,04L Ls 12.. 4(•,r?AZ-- Each add'I branch circuit 7,42 2
ll Miscellaneous(service or feeder not included)
Phone:(SiS) ) CP$.. 3 T(1z, Fax::( ) Z — 12,66 Each manufactured or modular 67.84 2
Email: 1�j`~ • dwelling.service and/or feeder
\,` £ �I ails?DX . (o' Reconnect only x 67.84 2
V NTRACrOR Pump or irrigation circle 67.84 2
Business name: N/I_ Sign or outline lighting 67,84 2
Signal circuit(s)or limited-energy Address: panel.alteration,or extension. 0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) I Fax:( ) Investigation(I hr min) 90.00/hr
Email: Industrial plant(I hr min) 78.15/hr
Inspections for which no fee is 90.00/In
CCB Lic.: I Electrical Lie.: I Suprv.Lie.: speciliically listed(7,hr min)
Suprv,Electrician signature,required: ELECTRICAL PERMIT FEES
Subtotal: 'I.,$L(
Print name: Date: 0 Plan Review Required(25%of permit fee):State surcharge(12%of permit fee): i 1¢
l 11
Authorized signature: TOTAL PERMIT FEE: -; 7 ,a62 This permit application expires If a permit Is nor rained within 80
Print name: Nir„J0. Tv s wr•��te__ Dale:\Z-(t�-ea days after It has been accepted as complete.
• Number of inspections allowed per permit.
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