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Permit 1 CITY OF TIGARD ELECTRICAL PERMIT '°'� '-' COMMUNITY DEVELOPMENT 9Permit#: ELC2021 00173 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 4/8/2021 iel z Parcel: 2S104AB13500 Jurisdiction: Tigard Site address: 12403 SW 134TH AVE Project: Nguyen Subdivision: MORNING HILL NO.7 Lot: 163 Project Description: New wiring for addition tap to main panel. 6/18/2021: Reprint to add(1)200 amp sub-panel. Contractor: OWNER Owner: NGUYEN, KIEN TRUONG-NGUYEN, KIM NGUYEN,ANDREW 552 N WHITE RD SAN JOSE, CA 95127 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 6 crt Branch Circuits w/Purchase 04/07/2021 $44.52 Specifics: Service or Feeder 1 ea 12%State Surcharge- 04/07/2021 $5.34 Type of Use: SF Electrical Class of Work: ALT 1 ea Services or Feeders-200 06/22/2021 $100.70 amps or less Type of Const: 0 ea 12%State Surcharge- 06/22/2021 $12.09 Occupancy Grp: Electrical Total $162.65 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. r Issued By: st_ Permittee Signature: - "- /1 '- _.';l r ./.. ,'7 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. NOtSI,1G oNin-1in9 a`d�1130 kl-n � Electrical Permit Application avo120Z 6 0 N1 City of Tigard Redeived �''� ` /j 13125 SW Hall Blvd.,Tigard,OR 972� Date/By (C. !I�),, 4,6' Perm"#:L-I_c. 70 Z1 —d v (7.3 Plan Review ' Phone: 503.718.2439 Fax: 503.598. �r�� Date/By: Related Permit s: Inspection Line: 503.639.4175 Ready Date/By: Jura See Page 2 for i I(' ;:I) Internet: www.tigard-or.gov NNotified/Method: I IN Supplemental Information TYPE OF WORK PLAN REVIEW ❑New construction ❑Addition/alteration/replacement i Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more ❑Building over three stories ❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. et-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural ❑Multi-family ❑Master builder amps for all other installations. buildings. ❑Other: ❑Fire pump. ❑installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived ) 0 Addition of new motor load of systemJob#: rob site address: © l� 10o1-[P or more. ❑"A-,"F,"l-2,•1-3 City/State/ZIP: Q ❑Six or more residential twits. t4ancy. � divkf�fX ©� �� �Z� ❑Health care facilities. ❑Recreational vehicle parka. $ Suite/bld ./ t.ff: Project name: ..� ') ❑Hazardous locations ❑Supply voltage for more than ��^2.2)2Z � ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I o+r. I Eaeb I Total I • New residential single-or mntti-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax map/parcel# 1,000 sq.R.or less 168.54 4 Ea add'l 500 sq.ft or portion 33.92 1 DESCRIPTI N OF WORK Limited energy,residential 75.00 2 ‘16./t- �, t� (with above sq.ft) J'� �/�P 1 0^. Limited energy,multi-family 4 1, 6�(5 r(r' 6 tot T`[ ('T_1 �'70 7.i 6G)17.j residential(with above sq.ft) 75.00 2 giPROPERTY OWNER 0TENANT Renewable Energy 0 See Page 2 1 G Services or feeders installation,al lion,and/or relocation Name: I�f V I vA.N/ t vf�K f asi c vJ ti 200 amps or less f 100.70 2 I 201 amps to 400 amps II 133.56 2 Address: i,7- l f o 3 Su) 1 3 7t'/se-/ 401 City/State/ZIP: r t ?,, amps to 600 amps 200.34 2 1 t�,�'�( +► I -7 oZo1-! 601 amps to 1,000 amps 301.04 2 Phone:((t$) � C F t Fax:( ) Over 1,000 amps or volts 552.26 2 7 iii s Temporary services or feeders installation,alteration,and/or Email: M(tc,5 IA.K 1 CNN&Vt 7 G A/1 li 'yet if-op- Lrn t---- relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 l 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: lUi • (- Date: 5/r,2 /v2.1 401 amps to 599 amps 168.54 2 0 APPLICANT J r9 I 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: - Ur n /m ' 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 56.18 2 branch circuit City/State/ZIP: Each add'l branch circuit 7.42 2 i Miscellaneous(service or feeder not included) Phone:( ) Fax::( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(I hr min) 90.00/hr Industrial plant(1 hr min) 78.18/hr Email: Inspections for which no fee is 90 Op/hr CCB Lic.: Electrical Lic.: Suprv.Lie.: specifically listed("A hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: I 2 , 7,' This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. l:\Buildrug-Permits\Et.C_PermitApp_ELR_ERE.doe Rev 06/172015 440-4615T(11/osico /WE8 Property Owner Statement RECEIVED Regarding Construction Responsibilities PIP - 9 2021 Oregon Law requires residential construction permit applicants who are not licensed with tfl� ' OF fiG ARD Construction Contractors Board to sign the following statement before a building permit NG DIVISION issued. (ORS 701.325(2)) This statement is required for residential building,electrical,mechanical,and plumbing permits. Licensed architect and engineer applicants,exempt from licensing under ORS 701.010(7),need not submit this statement.This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will jX1 reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. Print Name of Permit Applicant Signature of ermit Applicant Date /'/ Permit#: +►� 2( — b���J Address: INC? 5(--) 741 — >""lri ?i Issued by: Date: This Copy for Permit Offices CITY OF TIGARD ELECTRICAL PERMIT 111111 ■ COMMUNITY DEVELOPMENT Permit#: ELC2021-00173 T f G A R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 4/8/2021 Parcel: 2S 104AB 13500 Jurisdiction: Tigard Site address: 12403 SW 134TH AVE Project: Nguyen Subdivision: MORNING HILL NO.7 Lot: 163 Project Description: New wiring for addition tap to main panel. Contractor: OWNER Owner: NGUYEN, KIEN TRUONG-NGUYEN, KIM NGUYEN,ANDREW 552 N WHITE RD SAN JOSE, CA 95127 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 6 crt Branch Circuits w/Purchase 04/07/2021 $44.52 Specifics: Service or Feeder 1 ea 12%State Surcharge- 04/07/2021 $5.34 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $49.86 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. HollIssued B Van/De, t 't3e. ) Y: Permittee Signature: 0{V'gfihltCCi�WYI 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. E - 32, - h4 Electrical Permit APplicati44FCEIVE[. , ,,,; ,,F, It , I ., ,,., City of Tigard • xeceiv64 o`f j Pam;t a: EtGZ.oZ(_o(31.7 3 111. 13125 SW Hall Blvd.,Tigard,OR 97223 AAR 2 9 ZOZ S Phone: 503.718.2439 Fax: 503.598.1960 . ,�:, ® maw P«mga:M,STZO2D-{7UZ.(oC �. _ ,can Inspection Line: 503.639.4175 ;;ITY OF TI GAR D Ready Date/By: a s« z f� Internet www.tigard-or.gov NotifiediMc hodL'0 �4 2/ �� suppemePagaaw Inforautinn TYPE OF WORK ❑New construction Addition/alteration/ lacement Please check all that PLAN REVIEW roP apply(submit 3 seta of plum wfitems checked): Cl Service or feeder400 amps as more ❑Building over three stories. ❑Demolition 0 Other: where the amiable fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating bindings. 14.,1-and 2-family dwelling 0 Commercial industrial 0 Accessory building leas to gruwd,or exceeds 14,000 0 Commercial-use agricultural Y ❑Master builder ❑Other. amps for all other installations. bui ❑Muhi-family ❑Fite PAP ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived Job#: Job site address: j�3 Sty I ?) 1 ri t4,` . ❑Addition of new motor load of syaem. �F'� 100HP o more. ❑ City/State/ZIP: I ' A C J 2� O Sixth more residential units. ❑Retaeational vehicle parks. Suitt/bldg./apt#: Project name: 1....1.5 �/0� ,...004. 0 ifassedous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts comma/. Cross street/directions to job site: �1� 1\�"�._ (IV-• FEE SCHEDULE Irmviatiee I Qty. 1 Each 1 Tow 1 " Subdivision: New residential single-or multi-family dwelling unit Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.n.or less 168.54 ft,gr,S-44 Ea add'1500 sq.ft.or portion y 33.92 I 1 DESCRIPTION OF WORK Limited energy,residential '• �.�) itj1rin(-ti �1)/� (�1 12,1 - (with abovesq.ft) 7s.00 2 ay-AA � r', - ) Limited euerm,mvlti-faatily r tJ AA. T- �- fj -it (yu-TACT �/_ residential(with above sq.R) 75.D0 2 PROPERTY OWNER /r 0 , NANJYYIIT+��� t V`1 j( Renewable Foreign, ❑ See Page 2 Services or feeders installation,alteration,and/or relocation Name: K/6\, 4,5c0 N3 C-VA 7G14 200 amps orless 100.70 2 Address: it .2 q 03 5 tJ t13 y, �ktr 201 amps to 400 amps 133.56 2 ` 401 amps to600 amps 200.34 2 City/State/ZIP: Ti�gaL71a (y q 7,1P-3 601 amps to 1,000 amps 301.04 2 7) Phone:(( Oa) Y `(0s-I y ' F ( ) Over 1,000 amps or volts 552.26 2 Email: 1 Temporary services or feeders inslallatioa,alteration,and/or 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 exchan g to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: k I Date: I 22.1 Zj 401 amps to 599 amps 168.54 2 Branch circuits-new,alteration,or extension,per panel 0 APPLICANT ® CONTACT PERSON A Fee for branch circuits with Business name: above service or feeder fee, ( 7.42 2 each branch circuit Contact name: n u') r / circuits/1� e` �l�l� IT ti�1 B. service or faddy fee,first Address: Lk C 0 G I t \ C branch circuit 56.18 2 City/State/ZIP: C{T` ���J ti GGG"'lllJ C�. 9 -2�j/6 Each addl branch circuit 7.42 2 Miscellaneous(smite or feeder not included) Phone:(C��j)3 . I q I Fax::( ) Each manufactured or modular 67.84 2 Email: dwelling,service and/or keder Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67.84 2 Add[e55: Signal circuit(s)or limited-energy panel,alteration,or extension. ❑ Se.Page 2 2 Cityress: /ZIP: / Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 6625/br Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(1 hr min) 7818/hr Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lie.: Suprv.Lie.: specifically listed CA hr min) Suprv.Electrician signature, ELECTRICAL PERMIT FEES p required: Subtotal: (Nn'SI Print name: Date: 0 Plan Review Required(25%of permit fee): c, a .)4- AK • 1 / State surcharge(12%of permit fee): 2 - - Authorized signature: .�f �`VYw TOTAL PERMIT FEE: t l Y � J r, ` m ( ��i,,.t �te' / ( This permitapplication expiraa if a permit is oat obtained within it. Print name: .Kt I U v r 0t S / 1 days after it has been accepted as complete. Ir cis • Number ufinspections allowed per peewit. 1:lnuiMmgTenoits1ELC YormitApp ELK EREdoe Rev 06/17f2015 4404615r(11a15/COM/Wpa