Permit 111 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Per COMMUNITY
ELC2021-00076
Date Issued: 2/24/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S111 CB00700
Jurisdiction: Tigard
Site address: 14860 SW 103RD AVE
Project: Ziglinski Subdivision: DEL MONTE SUBDIVISION Lot: 6
Project Description: (1)branch circuits for fan,light fixtures,and outlet.
Contractor: OWNER Owner: ZIGLINSKI, JACOB L&DAVIA E
14860 SW 103RD AVE
TIGARD, OR 97224
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 02/23/2021 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 02/23/2021 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _. �_,.---- -- Permittee Signature: l/r/z i—A•)-
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.
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Related Permit x. �, ;'�.•f y¢,
f- f/ any 5{(;718.?s 1 ax, 503
q l 1n);Pecxu t plc .1 819 A 17S�y7 {t (} (� DIVISION
ha'= re Page 2 for
7/ { .”i'; )nfi'TNet m s;iert�1-or goy S LIt I.D I NICI DIVISION Supplemental Information
f�1t!.77704ff/.r.r 1 __ 1 t
/ili' ` 1/ TAPE OF w'oRh • t PLAN REVIEW 18
fez r'rlr'r/ 'OM '�Addition/alteration'rcp';welnent Please check all ohm apply(submit sets ul'pI I tchecked/
_ 7 f O Service or feeder 400 amps or more ❑Building over three stone
F,,,' i Oilier; where the available faith current ❑Marinas and boatyards
,,,,:,...„...,A eigla eff `` (A1'1.GORY OF r`ONSTRI IC I lOM exceeds 11000 amps at 15(i volts Of ❑flowing buildings.
/ I..log d.or exceeds 14,00(1 agricultural
1 t 4/ yiwklls;g ❑C ommelc n'indu tuidl ❑Accessory building ❑Commercial-use
/! Aj p I all tuber installations. buildings
'' I ❑E4f,or 1 ❑Master builder 0 tither. ❑1 pump ❑Installation of 150 Kvn or
(, r ❑rm g ncy system. larger separately derived
-�yr 1 i.ci:e 2 ff'' R '' INFORMATION : ' LOCATION ❑Ltnergen of new motor load of system.
-".-^ j Job 4r k b site address: il.ig,0 5y� 103' Ave. IO011P or snore ❑ A,••e,"1-z"."1-3',
-------- — — cs- .�7 �] ❑Su or mule residential units. occupancy
„/� I;,'il}`Sifitc+1OP: a 1< p,/ f j 2 t ❑i lealtb-care facilities. 0 Recreational vehicle parks
'— ""' '—' r ❑I lno rdous locations 0 Supply voltage for more than
$mil bt..___t ti._ i'ft)•)cii n:imt^,: �}l 1,4 A ❑service or feeder 600 amps or more. 600 volts nominal- `i
I Cross crlec0 d tee ;otot t it it it Lao, Mod FEE SCHEDULE l
Description sr. Each Total
_ __ New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage. r
--m'^ `
1,000 sq.ft.or less 168.54 4
r!: Tax map�pareei is _-� En.add'I 500 sq.ft.or portion 33.92 1 -
jf,'' - DESCRIPTION OF WORK Limited energy.residential '
f (with above sq.ft.) 75.00 2
, d s'r-I•Gl Q vtr\1 t.C Limited energy,multi-family
.-jam/ �,10 residential(with abovesq.ft.) 75.00 2
t'�e�—�e T,y � '� Renewable Energy 0 See Page 2
PROPERT).'OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
,17 Name: 3—a DRY t 0. 2.t 5\l �C 200 amps or less 100.70 2
Address: (L1�L ( } 1 V3`0. A l�. 201 amps to 400 amps 133.56 2
0 arm J1 401 amps to 600 amps 200.34 2
City/State/ZIP: 5w�� �� Lr�'�Z ZG,
601 amps tot,000 amps 301.04 2
Phone:(SOBS) 75('S _4263 I Fax:( ) Over 1,000 amps or volts 552 26 2
Temporary services or feeders installation,alteration,and/or
Email: Z,,,,` C.C.A dv1G1\ .LO" relocation
Owner installationhis insta'tat n is being made on property that 1 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 to 400 amps 125.08 2
Owner signature: Date: 1Z'Z,"ZD 401 amps to 599 amps I 168.54 2
0 APPLICANT I 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 7 42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first •
Address: J 56.18 branch circuit 9 '/ , 2
City/State/ZIP: Each add'l branch circuit 7.42 2
1 Dliscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular 67.84 2
Email:
dwelling,service and/or feeder
Reconnect only 67.84
CONTRACTOR Pump or irrigation circle 67.84
Business name: Sign or outline lighting 67.84
Signal circuit(s)or limited-energy
Address: ❑ See Page 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the abov
I Additional inspection(l hr min) 66.25/hr
Phone:( ) Fax:
( ) Investigation(I hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is'CB Lie.: I Electrical Lie.: Suprv. Lic.: specifically listed('It hr min) 90.00/hr
ELECTRICAL PERMIT FEES
uprv. Electrician signature.required: Subtotal:
nt name: Date: 0 Plan Review Required(25%of permit fee)'.
State surcharge(12%of permit fee): , 7 5/
'h orized signature: TOTAL PERMIT FEE: .„e`,'',,, ...
'� l�� This permit application expires if a permit is not obtained with
I name: 3Q. t/\s , Date: ,Z/ z / 2,0 days after it has been accepted as complete.
"'�-�' f J " Number of inspections allowed pet permit.
s. Parn;ts Ll C PermilApp ELR_ERE doe Res oo:'i 7/2015 430-1615T(11/051COAtMEB