Permit CITY OF TIGARD ELECTRICAL PERMIT
' 11 . COMMUNITY DEVELOPMENT Permit#: ELC2021 00018
T I ;A R.►:', 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 2/23/2021
Parcel: 2S 101 BC00500
Jurisdiction: Tigard
Site address: 12300 SW KNOLL DR
Project: Fredrick Stolt Subdivision: KNOLL ACRES Lot: 10
Project Description: (3)branch circuits in new and existing bathroom
Contractor: OWNER Owner: STOLT, FREDERICK
12300 SW KNOLL DR
TIGARD, OR 97223
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 02/22/2021 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 02/22/2021 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 OAR79�52-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987or 1.800.332.2344.
Issued B Holly V DEWege Permittee Signature: 0�App�CLU�n
Y
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 ApplicatiREcENED FOR OFFICE USE ONLY
13125 SW Hall Blvd,.Tigard,OR 97223
City 0/Tigard
Phone. 503.718.2439 Fax: 501.598.10(,(JAN 4
Deuedly: '''''' Pam" SLUSOB".OCO\el_
Related Permit a:
illalteriRt3evyiew
inspection dine: 500,630.4125 Ready Dte/By; ‘11 ,ei.i i hats Fil See Page 2 far
TIGARD
a Internet: www.rigard-or.gov jry OF TIGARD ro,it,,),.,dim,thod: %wiz% vw Supplemental Information
1" , —
'-- TYPE OF W II yr eta.i(.14.%PLAN REVIEW
3 New construction ErA Mit ionlaiteriMon,replacement Please circa all that apply(submit sets of plans wiitems checked):
0 Service err feeder 400 amps or more 0 Building over three stories.
0 Demo)t ion 0 Other: where the available flesh current D Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or 0 Hosting buildinpl,
al_
less to ground.or exceeds 14.000 0 Commential.use agricultural and 2-family dwelling 0 Cormnercial/industrial 0 Accessory building
amps the all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION El I ilicrgency system larger separately derived
— 0 Addition a
newmotor load or system.
Joh it: lob site address: t,D'6 Qcct) , S, ' D imp or more.
...0
0 Six or more residential units. occemancy
eityrstateiziP: -.. 4,?„ 9.1D'D I 0 Ilealth-care facilities a Recreational vehicle parks,
Suite/bldg/apt.4: I Project name: 0 Hazardous locations. 0 Supply voltage for more than
0 Service or(ceder OPO amps og more 600 Volt,1101T11041-
Cross street/directions to job site: N5,,r.h., Atii SIII.E.,__C't 16,j1, FEE SCHEDULE
V
k.o,t k Or, (:2‘..' ' ' ±_kt__ICt— New residential single-or multi-family dwelling unit,
Subdivision: Lot#: Includes attached garage.
i,(X/0 sq.11.or less 168.54 4
fax map/parcel 0. .
Ea.0(1(11 500 all.ft.or portion 0 33.92 0 I DESCRIPTION OF WORK Limited energy,residential
(svith above sq.IL) 0 75.00 0 2
4.0c2i.e-C....-__L-1201:1,Littl-A- Limited energy,multi-family 75.00 1.:;) 2
5 poitiir CA 07ekti ,.,side,„,a,(with above sq,ft.) ,
';:',+ .,J.4 PROPERTY OWNER i 0 TENANT Renewable Energy See Page 2
Services or feeders installation,alteration,&Indio relocation
Name: Fa eri' k ....-„t6 1*-- 200 amps or less
_......,....„..._ a7 100,70
2
201 amps to 400 amps 0, 133.56 2
,..-
City/State/ZIP: ./-- c.,,(5 nv ci— la: 601 amps to 1,000 amps 301,04 0 2
+54 — - -
Phone:(. A)) 3 — a( 5" Fax:( ) kJ/A Over 1,000 amps or volts 552.26 0 2
Temporary services or feeders Installation,alteration,anti/or
relocation _ _
Owner installation:This installation is being made on property that I own which is not 200 amps or less 6 59.36 ae— 1
intended for sale,lease,rent,or cxc mug,a ' ing to ORS 447,449,670,and 701. 201 amps to 400 amps 0 125.08 2
-
Owner signature:_ /2:11)0LI . _ Date: 401 amps to 599 amps e) ir,s.54 0. 2
,
Er APPLICANT 0 CONTACT PERSON Branch circuits- new,alteration,or extension,ter panel_
A.Fee Mr branch circuits with
Business name: e"-, ,, , above service or feeder'fee., 0
7.42 0 2
— each branch circuit
Contact name.
CI.'is-
. . ,4a Ak l'''' .....,- B.Fee for branch circuits without
. — service or feeder fete,first 1 56.18 `510)6. 2
Address: brassie circuit
City/Slate/ZIP: Filch arld'i branch circuit 3- 7.42 11-1.,84 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax:;( ) Each manuhicturcd or modular
0 67.84 L4 2
- dwelling:service and/or feeder
Email:
0 67.84 or 2
Reconnect only
CONTRACTOR _ Pump or irrigation circle .). , 67.84 ii 2
Business name: c--)LAT: 2,.._ Sign or outline lighting „) 67.84 2
Signal eirenitts)or limited-energy
Address: panel,alteration,or extension. 1:3 Stt Page 2 /6 2
Each additional inspection over allowable in any of the above ,
City/State/ZIP:
, Additional inspection II hr mint66.251 hr,
'
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00.,hr
Email:
Industrial plant II hr min.) 0 7 8.1 al hr 0
Inspections tier which no fee is rX .
t .00/hr
CCB L65
ic.: Electrical Lic.: Suprv. Lie.; specillealiv listed(Vt hr min) W )() -
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: ii 71.0,„.1.
......__
Print name: Date: D Plan Review Required(25%or permit fee): Alisiti-
State surcharge(12%of permit fee):
:
TOTAL PERMIT FEE: 4,.79,„c.,y
Authorized signature: 17-7 ,. -
,
— nos penult application expires if a permit is not obtained within 180
Erint name: ..-Trecitecie../.., st.,.,1-f- Date:
1
Number days after it hers heen accepted as vomplete.
" ber of inspections allorscd per permit.
IHrtoildinaMcinoWlil.C_ParaitApp_EMOME dor lies 0/17124113 .144,461STI I VOSICOMAKEI
11
,..
1 I.
r
Electrical Permit Application-City of Tigard
Page 2—Supplemental Information
'I Limited Energy Permit Fees: Renewable Energy Permit Fees:
s RESIDENTIAL WORK ONLY: FEE CHEDULE
TG7T-1,707-1-7.iiial
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less I 0 1 0.7
Check Type of Work Involved: )
3.01 to 15 kva I
133.56
2
L1 Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
_ Wind 1 eiteration systems in excess of 25 kva:
Burglar Alarm
2.501 to 50 kva 301.04 2
f. 50.01 to 100 kva 552,26 2
ri Garage Door Opener*
1 ......., ,iiio kva(fee in accordance
with 0.9 9i a-309.0040 552.26
Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional lo,a over 25 7.42 3
1 —
Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional ins ectinn over allowable in antof the above:
1 El Other: Each additional inspection is
66 25/hr 1
i — chared at an hourly(I hr min)
Inspections for which no lee is
90 80i hr .,
s vcificall listed 1,i,hr min!
I COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):L i Fee for each commercial system: $75.00
. Nunthcr of inhpixtiong allowcd per permit
(SEE OAR 918-309-0000)
Check Type of Work Involved:
Audio and Stereo Systems
Boiler Controls
E Clock Systems
0 Data Telecommunication Installation
I Fire Alarm Installation
0
El 11VAC
r Instrumentation
I I Intercom and Paging Systems
n Landscape Irrigation Control*
El Medical
Ejl Nurse Calls
E Outdoor Landscape Lighting*
El] Protective Signaling
_
Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I\linildikqe PertnitN,I.I I'I'm mi,App I A Ai Ill t do. Rel OS')7/201