Permit CITY OF TIGARD ELECTRICAL PERMIT
11111
_ COMMUNITY DEVELOPMENT Permit#: ELC2021-00311
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/9/2021
T f G;t R i� g Parcel: 2S102CD01400
Jurisdiction: Tigard
Site address: 13565 SW ASH AVE
Project: Goulet Subdivision: FREWING'S ORCHARD TRACTS Lot: 16
Project Description: Wiring accessory structure
Contractor: POWER ELECTRIC INC. Owner: GOULET, LAURA M &GERALD T
PO BOX 14692 13565 SW ASH AVE
PORTLAND, OR 97293 TIGARD, OR 97223
PHONE:
PHONE: 503-703-2801
FAX: 503-786-5462
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 06/07/2021 $100.70
Specifics: amps or less
4 crt Branch Circuits w/Purchase 06/07/2021 $29.68
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 06/07/2021 $15.65
Electrical
Type of Const:
Occupancy Grp:
•
Total $146.03
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.
Issued By: 140 Vc.wVe.44)ege Permittee Signature: OwAppUCCLaofl
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 colt turned_ I.SL ONLV
CityofTigard Received 42ritz\ ) Permit#:ELC2( 1-0c3\,
III— 13125 SW Hall Blvd.,Tigard,OR 97223 plan Review
g Phone: 503.718.2439 Date/By: Related Permit 4:
TICARD Email: TigatdBuildingPeamitsa®Tigard-or.gov Ready Date/By: � ...i\zx .tv hub: I ® See Page 2 for
Inspection Line: 503.639.4175 Internet: www.tigard-or.gov Notified/Method: r'1gl 1, . Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction Idition/alteration/replacement Please check all that apply(submit2 sets of plans w/items checked):
Li Demolition El Other.
Service or feeder 400 amps or mom ❑Building over three stories.
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
0 1-and 2-family dwelling 0 Commercial/industrial Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ Multi-family El Master builder ❑Other Fre amps for all other installations. ImOdlatio
❑Fe pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATIONN j ❑Emergency system. larger separately derived
i lob#: l-`f c a Job site address: / S. f f - A 5� n0 ❑Addition of new motor load of system.
02 j ��s N7 S HVu.. 100HP or more. ❑••A•,>E'•,••1_2"••1-3,•,
City/State/ZIP: "rjEg Q3.-, ftn1,72--3 0 Six or more residential wails. occupancy.
❑
�rff ❑Health-care facilities. Recreational vehicle parks.
" Suite/bldg./apt.#: Project name: G Ok,A_Cr' 0 Hazardous locations. ❑Supply voltage for more than
0 Service or Breda 600 amps or more. 600 volts nominal.
Cross street/directions to j site: FEE SCHEDULE
‘..)‹.. Description I Ow. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: X Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited ener residential
gy' 75.00 2
`n/'1Y'N C,-Q.C.{-5.< Or" �j-'tr-t!,C,/ k - (withabovem ft.)
r-e Limited energy,,multi-family 75.00 2
Nv.x s t`C f`-y G(& residential(with above sq.ft.)
0 PROPERTY OWNER e I ❑ TENANT Renewable Energy ElSee Page 2
Services or feeders installation,alteration,and/or relocation
Name: 2^.. 200 amps or less j 100.70 f di C,1Cf
Address: \ J 201 amps to 400 amps 133.56 2
City/State/ZIP: /�[ 401 amps to 600 amps 200.34 2
,/ 601 amps to 1,000 amps 301.04 2
Phone:( Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
� relocation
Owner installaatio This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sk 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 El CONTACT PERSON 1Branch circuits—new,alteration,or extension,per panel
A Fee for branch circuits with
Business name: _ above service or feeder fee, iii
each branch circuit 7.42 `1, gs 2
Contact name: fF B.Fee for branch circuits without
service or
Address: 1..." a, branchfeeder fee,first 56.18 2
circuit
City/State/ZIP: / \ Each add'l branch circuit 7.42 2
\ _, Miscellaneous(service or feeder not included)
Phone:( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: J O\44,i 6 f Gtr; t, , ...04.... c.. Sign or outline lighting 67.84 2
Address: 0 I Y 6,?vim- panel,,alteration,cirwti(s)or limited-energy
❑ See Page 2 2
pane], or extension.
City/State/ZIP: ��r 6A A O-,,, c"lg 47 3 Each additional Inspection over allowable in any of the above
...1Additional inspection(1 hr min) 6625/hr
Phone:( ) g ) ")O3.r�"'so ! Investigation(1 hr min) 90.00/hr
�y
Email: OW'a✓et-e n to L2i CA't+^�S i -s AlL� Industrial plant(Ihrmin) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie" l fir--tg O 9 Electrical Lich 6-./p Cl t Suprv.Lie.:L/4t j'8 S specifically listed(/a hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ip . r
39
Print name'- ) ` " c�^,)}.1�� ` c Date: 6-7..�t l 0 Plan Review Required(25%of permit Subtotal:ee): tr
' ��^�C • State surcharge(12%of permit fee): /.may.64,
TOTAL PERMIT FEE: /y ,D 2.Authorized signature:
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
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