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Permit
CITY OF TIGARD ELECTRICAL PERMIT II ■. COMMUNITY DEVELOPMENT Permit#: ELC2021-00175 TIGARD 13125 SW Hall Blvd..Tigard OR 97223 503.718.2439 Date Issued: 4/8/2021 Parcel: 2S104AB06300 Jurisdiction: Tigard Site address: 12162 SW 131ST AVE Project: Roast Subdivision: MORNING HILL NO.4 Lot: 92 Project Description: Extend circuit to gas fireplace Contractor: OWNER Owner: ROAST REVOCABLE TRUST 12162 SW 131ST AVE TIGARD, OR 97223 • PHONE: PHONE: FAX: FEES Quantity Description Date Amount 1 crt Branch Circuits wo/Purchase 04/07/2021 $56.18 Specifics: Service or Feeder 1 ea 12%State Surcharge- 04/07/2021 $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. YouYo may obtain1 .a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: `si11 t �t�lt' 1`)o Wc- - Permittee Signature: C)� �(�)(Lei hL:\ 1 ` ' 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�Pe�rm�t Application RECEIVED ����� ��� - ����FF'i'c"�USE oNLA _ t f g :Zo2I pd/75 13i25 SW Han Blvd.,Tigard,OR 97223 MAR 3 0 202E Plan Review PI,mmi 503 7I S.2439 Pax; 303.598.1960 Date/By: Li Related Permit#: Inspection Line: 503.639.4173 Iari: Id See TC&AR7 CITY OF TIGARD Rfor Internet www.figard-or.gov Nottfied/Mtthod: Supplemental Information rmation TYPE OF WOIR-� G DIVISION' PLAN REVIEW ❑ New construction -.ddition/alteration/replacement - Please check all that apply(submit l sets of plans w/rictus checked).------- - El Demolition LLL❑���"'Othee 0 Service or feeder 400 amps or more ❑Building over three stories. where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. and 2-family dwelling CI Commercial/industrial El Accessory building less to ground or exceeds 14,000 ❑Commercial-use agr cultural amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address; 0 Addition of new motor load of system. t2t 6.7.....s4.,m/33 1 f9� IOOHP or note. - City/State/ZIP:fF, �; C7 ? ❑Six or more residential units. Recreational aneV. ,. > ,- / _?. .23 _- __ 0 Healthcare facilities. ©Recreational vehicle parks. Suite/bidg./apt•#r J Project name: 0 hazardous locations Q Supply voltage for more than ...._._ __ ._ ❑Service or feeler 600 amps or more. 600 volts nominal. CAM strooklireetions to job site: c Se.✓ 7-y E-1e L/LtF- FEE SCHEDULE Descdntieo I Qty. l Each I 'I ulal l — � / New residential single-or multi-family dwelling unit. Subdivision: Y Lot#r ( ,, includes attached garage, __a� - 12ht--/lt !> r LG.r 1,000 sq.0.or less --- 168.34 4 Tax map/parcel#i -. _ _ _-_. — -_ _. .. Ea.add'I 500 sq.ft.or portion -_. 33.92 -DESCRIPTION OF WORK - - -- -- Limited energy,residential- 75.00 2 1Z=Y T G' i..C� .,_i t __ p C-�P..�+ (with above sq. -.. - ���l Limited energy,,multi-family ----- -- residential(with above sq.0.) 75.00 2 P �L G+- Renewable Energy 0 See Page 2 iliROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: _-.�FAA h7 �otti�T 2(8)arrta or lees 100.70 2 Address: T' 201 amps to 400 amps 133.56 2 - - - - ! 401 amps to 600 amps 200.34 2 City/State/ZIF L ! A Q Lr"j � 1 601 . amps 301.04 2 � _ to 1,000 Phone; "78/ �Z Jr5 Fax:( ) Over 1,000 amps or volts 55226 2 -"- - _--- --- - Temporary services or feeders installation,alteration,and/or Email: A L.. IZea,aN- -5 s-a Cam_ /401- ^-7 AI.I G., Cam.r--1 __ relocation Owner hielallatlnni 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: 401 amps to 599 amps 168.54 2 ❑ APPLICANT ID CONTACT PERSON Branch circuits new,alteration,or extension,per panel A.Fee Mr branch circuits with Business name: above service or feeder tide, 7.42 2 each branch circuit Contact name: - B-Fee for brunch circuits wi[&rpdt Address: -_-_ ----- service or feeder fee,first 56.18 _-- branch circuit S 6-��2 City/$fate/ZIP: Each add'1 branch circuit 7.42 2 -Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Patch 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 fighting 67.84 2 Address: Signal circuil(s)or limited-energy Address: Page 2 2 panel,alteration,or extension. City/State/ZiP: Each additional inspection over allowable in any of the above... Additional inspection(I hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr Industrial plant(I hrmin) 78.18/hr Email: _�-_. ___ — Inspections for which no fee is 90.00/hr CCH Lic_: Electrical Lic.: Suprv.Lie.: -specifically listed(A hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: ,5K., /g Print name: e; ElPlan Review Required(25%of permit fee): '� /' -- - ------ -- State surcharge(12%(domed fee): 6 - '7 7 Authorized signature: (7 TOTAL PERMIT FEE: 2 ,9 Z This permit application espirea Ira permit is not obtained within 180 Print nanle3 �.-t- � � P_- ��L cSr Datet3/T�/'/^.,,( e / days after it has been accepted as complete. J * Number of inspections allowed per permit. I.",Building\PermitslELC_PemtiApp_ELR ERE-due Rev 06/17,2015 440-40f 01/051 },UWEn