Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2021-00174
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 4/12/2021
T f[;;�R C? 9 Parcel: 2S109DD07800
Jurisdiction: Tigard
Site address: 15615 SW GREENFIELD DR
Project: Schwartz Subdivision: BELLA VISTA Lot: 8
Project Description: Adding 50 amp breaker and NEMA 14-50 outlet for 240 Volt EV charging
Contractor: OWNER Owner: SCHWARTZ, JORDAN&TANYA
15615 SW GREENFIELD DR
TIGARD, OR 97224 •
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 04/09/2021 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 04/09/2021 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.3322344.
Issued By: ?fOU)VW11"DPiWeee Pe rmittee Signature: 0wApplLCariXtt
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OIFICE USE ONLY
City of Tigard E C E I V Date/By:
a� �� -9 �^ �/^,j (7.
III Plan Rev Permit i!:e H
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
= Phone: 503.718.2439 Fax:503.598.1960 9 '1 Date/By: ✓/ Related Permit 4:
Inspection Line:503.639 4175 MAR 2 9 02,
TIGARD
Ready Date/By �/y/, ions O See Page 2 for
Internet:www.tigard-ofgov • r • ' Notified/Method:$ '/^ Supplemental Information
T t" '1, s.�- ..,� gF, v'.!_"'LANREVIEW .,
❑New construction E Addition/alteratio repacement Please check all that apply
pp y(submit 2 sets of plans w,items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.0 Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTIMMN exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ amps for all other installations. buildings.
0 Multi-family 0 Master builder Other: ❑Fire
pump. 0 Installation of 150 KVAor
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job siteaddress: 15615 SW GREENFIELD DR ❑Addi on of new motor load of system.
100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: TIGARD OREGON 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 240 VOLT OUTLET 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: BEEF BEND RD. FEE SCHEDULE
t•
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTI' ORK Limited energy,residential
ADDING 50 AMP BREAKER AND NEMA 14-50 OUTLET FOR (with above sq.ft.) 75.00 2
240 VOLT FV Charvina Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
I
X PROPERTY OWNER TENANT Renewable Energy I I See Page 2
Services or feeders installation,alteration,and/or relocation
Name: JORDAN SCHWARTZ 200 amps or less 100.70 2
Address: 15615 SW GREENFIELD DR 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: TIGARD OREGON 97224 601 amps to 1,000 amps 301.04 2
Phone: ( 503) 442-1322 Fax:( ) Over 1,000 amps or volts 552.26 2
Email: JORDAN954RR@GMAIL.COM Temporary services or feeders installation,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 exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: _ - "-/ Date: 2-22-21 401 amps to 599 amps 168.54 2
APPLICANT 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
Address: service or feeder fee,first 56.18 l 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular
Email: dwelling,service and/or feeder 67.84 2
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
panel,alteration,or extension. ❑ 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:( ) hr min Investigation(I
g ) 90.00/hr
Email: Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: Electrical Lic.: Suprv.Lie.: specifically listed(/r hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: $56.18
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): $6.74
Authorized signature: TOTAL PERMIT FEE: $62.92
This permit application expires if a permit is not obtained within 180
Print name: JORDAN SCHWARTZ Date: 3-22-21 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits'ELC_PermitApp_ELR_ERE.doc Rev 06/17,2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: `'
FEE SC t `
Description I Qty. Each I Total
Fee for presidential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
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:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
s citicall listed '' hr min
COMME •
Subtotal(Enter on Page l):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required.Licenses are required for all
other installations
I:\Building\Permits\ELC_PtzmitApp_ELR ERE.doc Rev 06/17/2015