Permit CITY OF TIGARD ELECTRICAL PERMIT
14
_ ' COMMUNITY DEVELOPMENT Permit#: ELC2021-00109
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 3/10/2021
Parcel: 2S111BA02106
Jurisdiction: Tigard
Site address: 9835 SW INEZ ST
Project: Walker Subdivision: INGEBRAND HEIGHTS Lot: 13
Project Description: Replace main breaker
Contractor: OWNER Owner: WALKER, SAMUEL JAY&JULIE LINDA
9835 SW INEZ ST
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
Specifics: 1 ea Services or Feeders-200 03/07/2021 $100.70
amps or less
1 ea 12%State Surcharge- 03/07/2021 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
11
Total $112.78
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 throu h OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: VnV C1VI12f2.�-e-
Permittee Signature: Cr\ C( `, (,i-: CC�-{��_
OWNER INSTALLATION ONLY 1
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
o 1 rE
Electrical Permit Application
l�ECEI\,
City of Tigard 13125 SW Hall Blvd.,Tiprd,OR 97223
■ Phone. 503.718,2439 Fier 503.591.1960
tmpalion Lint. 503.639.1175
Internex: wwwtigrd-orcw
i
_
AR .L202 r z y4 Pond 'L(�20Z1-00i o4
P.Review
ReL,ITY OF edy
Type or wow %u1DING DIiSIO _Retard Paten+
twit a gee Inge llerarw..Slopplemommil ar
mom�r"R.,.EV� S
❑New construction ®Addition/altcre s
Addition/alteration/replacement Poem ypybb( wit Vtd elms shameaaaeaadY.
0 Ponied or leader 440 amps or arse 0 Rind al ow doe wore.
❑Demolition 0 Other: wane die evadable w awe O Morino sod lmatywi.
CATEGORY OF COPIP$%UCfON aimed,10,000 amps at 150.dui w 0 Firma,Mai..
lab to mooed,a ambb 14,000 0 Car am atieedl ni
®I-and 2-family dwelling ❑Cortarrercial/industrial ❑Accessory building amps S,r Mho inNhiona Wilma
❑Multi-family 0 Master builder 0 Other 0 Fire pimp O irraiw d 150 KVA or
JOB SITE INFORMATION AND LOCATION CI Freemency system Imam some*derived
O Addition dam motor toadd mime
Job N: l Job site address:9835 SW Incz St. I08F4P or were 0 "A 'E."1-2^."1-T.
❑six or more reddened scan. moms,City/StatrlZlP: Tigard/OR/97224 p Hbhheae realms. O Reanstiond mbar parka❑Hanrdom lomaa. 0 Sway raises for owe awe
Suite/bldg./apt-N: Project name: ❑Service or Seeder 600.rps w soar 600 1e19 ever=
Cross street/directions to job site: via u
Dmoyew I Ow. I saw 1 terra I •
New resideadi single-sr aallf-family iodic m it
Subdivision: Lot ii: Iadadei attached garage.
1,000 sq.It or less 161.54 4
Tax map/parcel is -
Fa add')500 sq.R or prelim 33.92 r
DE.SCRIrnON OF WORK Limited mew,residential 75.00 2
(with above sq.R)
Replace main breaka Limited energy,mdIt ra ily 75.00 2
residential(with shove sq.ft.)
Reeewabk Energy ❑ See Page 2
IS rROrPlt7Y OWNER 0 TENANT Services or feeders imagination=alseriden,maw rdscanaw
Name: Sam Walker 200 amps or less I 100.70 2
201 amps to 400 amps 133.56 2
Address: 9835 SW Inez St 401 amps to 600 amps 200.34 2
City/State/ZIP: Tigard/OR/97224 601 amps to 1.000 amps 301.04 2
Phone:( 503)443-6085 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders laws Medea.aletsaiisa,aadrr
Email:samweng vomcast.net relocation
Owner installation:This installation is being made on properly that I own which is not 200 amps Or less 59.36 I
intended for sale,1 ,rent,or elCcb ge,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.0S 2
Owner signature: Date:2-i 6/�` 401 amps to 599 amps 168.54 2
• tCONTAcr PERSON Branch circuits-mew,alleratiea,or easeaam Plod,err d _
® ArrucANr A.Fee for branch circuits with
Business name: above service or feeder fee, 7 42 2
each branch circuit ,
Contact name:Sam Walker B.Fee for branch circuits wirbod
service or feeder fee,fast 56.1S 2
Address: 9835 SW Inez St branch circuit
City/State/ZIP: Tigard/0R/97224 Each NMI branch circuit 7 42 2
Miacellaaeoas(service or feeder not lac ailed)
Phone:(503)443-6085 Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: sanweng®comeasinet Reconnect only 67.14 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.14 2
Sigtwl circuit(s)or limited-main' 2 2
Address: panel,alteration,IN extension. 0 See Page
Each additional inspection over allowable is say of tic above
City/State/ZIP: Additional inspenion(I br min) 66.25/Par
Phone:( ) Fax:( ) Investigation(I hr min) _ 90.001 hr
industrial plant(1 hr min) 78.1 S/Par
Email: Inspections for which no fee is
-
specifically �hr
CCB Lic.: Electrical Lic.: Suprv.Lie.: lly listed(%Par min)
PERMIT PER
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature: TOTAL
permit application expires it if a permit not obtained oldie 18i
Print name: Date: I days after it bed bees accepted to complete.
• Electrical Permit Application—City of Tigard
Page 2-Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: t>Tc $C71/DU LL
•
Fee for ISII residential systems combined: S75.00 ilese a i toQ. I I �++ 1
tieaewabk electrical entp system
5 kva or less 10070 2
Check Type of Work Involved:
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to25 kv. 200.34 2
Wild amenities systems is cacao 425 kva:
❑ Burglar Alarm 25.01 to 50 kva 30104 2
50.01 to 100 kva 55126 2
❑ Garage Door Opener* >l00 kva(fee in accordance
55226 2
with OAR 918-309W-00)
❑ Heating,Ventilation and Air Conditioning Solar geseraties systems he cute of 25 krs:
System* Each additional kva over 25 7.42 3
El Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over*Sayable hi a of the above.
ElOthercharged an hourlyional (I �)on is 6625/tr
Inspections for which no fee is 90.00/lir
specifically listed(h hr min)
COMMERCIAL WORK ONLY: ELectwCAL PERMIT FEES
Subtotal(Enter on Page Fee for ash commercial system: 875.00 I):Numhcofon albwedperpermi�
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
❑ Other.
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations