Permit CITY OF TIGARD ELECTRICAL PERMIT
' -' COMMUNITY DEVELOPMENT Permit#: ELC2017-00945
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 F Date Issued: 12/21/2017
TIGARD Parcel: 1 S 134CC00600
117 aJ Jurisdiction: Tigard
Site address: 12175 SW MERESTONE CT
Project: Hartshorn Subdivision: MERESTONE Lot: 5
Project Description: Relocate laundry room and move(4)branch circuits for dryer,bedroom,bathroom and living room. 2/8/21:
REPRINTED permit to include(3)additional branch circuits for bathroom heat,washing machine,and exhaust fan.
Contractor: OWNER Owner: HARTSHORN, THOMAS W
12175 SW MERESTONE CT 12175 SW MERESTONE CT
TIGARD, OR 97223 TIGARD, OR 97223
PHONE:
PHONE: 503-268-3918
FAX:
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo/Purchase 12/21/2017 $78.44
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/21/2017 $9.41
Type of Use: SF Electrical
Class of Work: ALT 3 crt Branch Circuits w/Purchase 02/08/2021 $22.26
Service or Feeder
Type of Const: 0 ea 12%State Surcharge- 02/08/2021 $2.67
Occupancy Grp: Electrical
Total $112.78
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.
•
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Issued By: Permittee Signature: t�
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.
r IVE _- I26/2 (
Electrical Permit Application FOR OFFICE USE ONLY
Received ,} y�
City of Tigard JAN 2 2021 Date/By. . all /.7f7-- Permits: E tiP617— 001its-
1 a 13125 SW Hall Blvd„Tigard,OR 97223 Plan Review !7U ` Y
1 ®., Phone: 503,718,2439 Fax: 503.598.196 I'� OF TIGARD Date/By: Related Permit#:
Inspection Line: 503 639 4175 Ready DateBy. Stria: ^�+ VI See Page 2 for
TIGARD Internet: svww.tigard-or.gov Ol ti Iv.`.i 'N„. Notified/Methodl1.7r Supplemental Information
FYPE OF WORK W_t AL REXTE4l _ r-
❑ Nevv Construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w nuns checked)
❑Service or feeder 400 amps or more 0 Building over three stones
El Demolition ❑Other: add to existing permit ELC2017-00945 .
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
El 1-and 2-family dwelling ElCommercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑commercial-use ag icuhural
amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑Oth ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION:-9 I t `i ai �;), •si` 4 __' 0 Emergency system. larger separately derived
.__ vain.
i� `"' ['Addition of new motor load of system.
Job#: Job site address: 12175 SW Me estone et! 100HP or more. ❑"A"."E","1-2","1-3",
I' A
City/State/ZIP: Tigard Oregon 97223 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: SW 121st and Merestone ct FEE SCHEDULE
De,npiian I QtY. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot*: Includes attacked garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel 4: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK „ Limited energy,residential 75.00 2
Add 3 branch circuits for bathroom heat,washing machine, and relocate fan switch" (wtnabovesq.@.>
/�, Limited energy,multi-family 75.00 2
e'g.W'-tt e )t nc cr.,.-�.. I t 'S R t'l. 1'r`0 t t.C residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
.:PROPERTY:OWNER ❑,TENANT
- - - -! Services or feeders installation,alteration,and/or relocation
Name: Thomas Hartshorn 200 amps or less 100.70 2
Address: 12175 SW Merestone ct 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard Oregon 97223 601 amps to 1,000 amps 301.04 2
Phone:( 503) 268-3918 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: hartshorn3778@comcast.net 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_ tow ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Ti gins.�_s f"fry/in +. Date: 01/28/2021 401 amps to 599 amps 168.54 2
- ' l- *II -cr -- Branch circuits-new,alteration,or extension,ter panel
❑ Ali " l ; A.A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first
branch circuit 56.18 2
City/State/ZIP: Each add'I branch circuit 3 7.42 22.26 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
Address: Signal circuit(s)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP:
Additional inspection(I hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr train) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lie.: Suprv.Lie.: specifically listed(v,hr mirth
ELECTRICAL PERMIT FEES =i'
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: 4 TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within ISO
Print name: Thomas Hartshorn Date: 01/28/2021 days after it has been accepted as complete.
e Number of inspections allowed per permit.
1.\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-46151111/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
5fY1l
Fee for all residential systems combined: $75.00 an e° Each moil .
y Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ 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* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ 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:
n 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('h hr win)
COMMERCIAL WORK ONLY: mil .p=,•,' ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(enter on Page I),
y W Number of inspections allowed per perms_
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n 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 for all
other installations
1.\Building\Permits\ELC PermitApp_ELR_ERE.doc Rev 06/17/2015
Branden Taggart
From: #Building Permit Technicians
Sent: Monday, February 8, 2021 1:11 PM
To: 'hartshorn3778@comcast.net'
Subject: RE: updated addition to ELC2017-00945
Attachments: permit addition2.pdf; Invoice.pdf
Hi Thomas,
I have revised your existing permit ELC2017-00945 to include (3) additional branch circuits. The balance due is$24.93,
and I have attached an invoice above for you to reference. This fee can be paid online now at https://aca-
prod.accela.com/TIGARD/Welcome.aspx by searching for the permit record number ELC2017-00945 under the Building
tab.There is a 3%service fee for credit cards, but e-checks do not have a service fee.
Once this fees is paid, please email the Permit Technicians at TigardBuildingPermits@tigard-or.gov. After payment is
made, we will email the revised permit paperwork to you.
Thanks,
Branden Taggart
1,4 r City of Tigard
Senior Permit Technician
Community Development
T1GA i)
13125 SW Hall Blvd
Tigard, OR 97223
(503)718-2449
brandent@tigard-or.gov
From:TOM HARTSHORN <hartshorn3778@comcast.net>
Sent:Thursday,January 28, 2021 6:03 PM
To:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: updated addition to ELC2017-00945
Caution! This message was sent from outside your organization.
Hello,
Hopefully this updated request for permit additional branch circuits is acceptable. Please let me know
if you need any additional information.
Thank you,
Tom Hartshorn
t