Permit CITY OF TIGARD74
ELECTRICAL PERMIT
: p COMMUNITY DEVELOPMENT Permit#: ELC2020-00652
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/22/2020
Parcel: 2S106AD08500
Jurisdiction: Tigard
Site address: 16973 SW FRIENDLY LN
Project: Cardona Subdivision: RIVER TERRACE EAST Lot: 192
Project Description: Add(3)additional branch circuits to outdoor GFCI switch.
Contractor: OWNER Owner: ROSARIO,ANGEL E CARDONA
BERRIOS, LORENA MONTES
16973 SW FRIENDLY LN
BEAVERTON, OR 97007
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 12/22/2020 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/22/2020 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total S79.54
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 95 -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: X.1 Y', 14:, er ,,S.= Permittee Signature: 6'"4'' y-/- /'rY7/(- f. •'
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 Applicationel
f()R Olrl 1C'!' 1'SE ONI.I'
Cityof Tigard
b � ,. Received Permit k''
1111 n 13125 SW Hall Blvd.,Tigard.0 -�- -I' Datelli
0 Phone: 503.718.2439 3, 97219 �•Fax. 50359 Pleo Revew Related Permit q: �.
Inspection Line: 503.639.4175 8.1960 y I i- Dtc7B : pats: ® See Page 2 for
T I C,A ItI. Internet: www tigard-or. ov - ` Ready Date/By ,
gPplemeaFai 1
NonficNMctnod ,� - afar
..,,' 'PExOE.Sya n [ ,, re .. ;m REv1EW w,s•rsrt i.
❑New construction a dition/ "'^, ^'""a'-` e,,r°''° 1- �� ` PPY Pl mwhrimaubeckcdl&t
. Ad
alleratio Please check nil that a I (submit 2 sets of e "
Demolition ration/replacement
- •CATEGORY OF where the available fault current 0 Marinas and boatyards
CON sat I50 volts or ❑Floosn n buildings °a
iROCCION, exceeds 10,000amP g
1-and 2-Family dwelling ❑Commercial/industrial
o -``'-'-- ground, me agricvhural
tmnerCtalh less to und,or exceeds 14,W0 ❑Cosmmtrciab
ndustrial ❑ building
buildings.
Multi-familyAccessory g asnpstarallotherinstallations.
❑Master builder ❑bmstallSepi of ISO r
JOB SITE INFO Other:0 ❑Fire pump. or
INFORMATION ❑Emergency system. large separately derived
AlVA LQCATIOa , system
Job#: Job site address: i- ❑Addition of new motor load of
/�(y-yam,) G
CitylSlate ZIP: —t-"-'f �+ �tiGsH +t IOOHP or more. ❑occupancy,
���/ff Recreational
❑Six or more residential unto. ❑Recreational yank.parks.
SuiteIbldg.lapt,#: Project 10 ❑Health-care facilities. ❑Supply S for
Su I voltage ,ore than
1 name; }iarardous kcasions. 600 volts nominal
Cross street/directions to job site: LID scrncc or tceder 60o amps or morn.
,FEE-SCHBDllLEr '
ncacrlptNa Qn l Each l ToW -4- ,
Subdivision: n' New residential single-or.multi-family dwelling unit.
C[l_Vcr T rr.
Tax map/parcel#: r� ( Lot#: lndndes attached garagn.
1,000 sq.ft.or less 168 54
92 4
M_ DESC Ea.add'!500 sq,ft.or portion 33.92 )
RLPTIOK ;WVRK` • i.h.h s., _
! C-e 3 J , Limiter!energy,residential 75.00 2
Gi J ocie t iips{0 i ' et 5 (with above sq. .)
PM Ou I�r ` G ,/t"P t�rC� LltGttr L �O Limited rnergy,multi-family 75.00 2
C J r ro keil sw/ie4 residential(with above sq.ft.)
PROPERTY OWNER ° ,,i Renewable Energy 0 See Page 2
TENANT,
Name: yl e 1 Services or feeders installation,alteration,and/or relocation
--at'eng Q 200 amps or less 100.70 2 ':
Address: 1/® '7 `S..r , r,,/ j , 20I amps to 400 amps 133.56 2
City/State/ZIP: S W Clt4 (/ `/1 401 amps to 600 amps 20D.34 2
of leerplq p ✓
Phone: -` �� 601 amps to 1,000 amps 301.04 2
(7g>) i1SS-49 Fax:
[y ( ) Over 1,000 amps or volts 552.26 2 !,
Email: .C t. 2 �] n p iJa^ li.Q Temporary services or feeders installation,alteration,and/or
-�+�/�O e J 4a !/. Cam'/ relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 5936 I
intended for sale,lease,rent,ore rding to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date 401 amps to 599 amps
7//j/Zd Pp- 16R.54 2
0 APPLICA Q'CONTACF PERSON Branch circuits-new,alteration,or extension,per panel
Business name: A.Fee far branch circuits with
-- above service or feeder fee,
Contact name: each branch circuit 7•42 2
B.Fee for branch circuits without
Address: service or feeder fee,first
branch circuit / 56.18 2
City/State/ZLP: Each add9 branch circuit "' 7.42 2
Phone:( ) I Fax::( ) . Miscellaneous(serviceorfeedernotincluded) 1
Each manufactured or modular .,
Email: dwelling,service and/or feeder 67.84 2
CONTRACTOR .' Reconnect only 67.84
- Pump or irrigation circle 6784
i BILJrt name: .
Sign or outline lighting 67.84
Address: Signal circuits)or limited-energy
i" - panel,alteration,or extension. ❑ See Page 2 2
i.r%`Stase,'2IP: Each additional inspection over allowable In any of the above
I Additional inspection(I hr min) 66.251 hr 1
4t3,( Fax: )
Investigation(1 hr rain) 9000(hr `.t
&'.ail: _. Industrial plant(I Iu min) 78.18!hr
_. Inspections for which no fee is
FB L'c Electrical Lie.: Suprv.Lie.: specifically het 'h hr min) 90.001 hr i
4,.<a^ Etcchic:a signature,required: ELECTRICAL PERMIT b ES °.
Snbuxet.
(?flat raar'es I Date: 1 ,0 Plan Review Required(25"- of penult tee} t
i
�? State surcharge(l2 Yo ofpuvmit fee) s a}},
Authorized sign.atire: TpTAL Pp e sdfT i LrAA, `Al s f
§ ill
U" f-La',k: This permit application expires if a peremt:s,anl *d
.... /(' -Date: d' } M .i da a
days after has been act ep%,c*to " ,
".°•ts^ ^' sn i,[,f"t tttpp€iF F,f d'w Rev Gfi,3 21Y13 s 'A° it`} x r,r P , 'nSatl7wCz{p��tF, + r
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