Permit CITY OF TIGARD ELECTRICAL PERMIT
•IN 11COMMUNITY DEVELOPMENT Permit#: ELC2021-00197
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 5/27/2021
Parcel: 1 S 136AA10800
Jurisdiction: Tigard
Site address: 10186 SW 69TH AVE
Project: Caldwell Subdivision: OAK STREET ESTATES Lot: 3
Project Description: Electrical for new pool:(1)feeder,(7)branch circuits,and(1)pump circuit.
Contractor: OWNER Owner: CALDWELL,TRICIA& RYAN
MILLER, BRIDGET
10186 SW 69TH AVE
TIGARD, OR 97223
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
7 crt Branch Circuits w/Purchase 05/19/2021 $51.94
Specifics: Service or Feeder
1 ea Pump or Irrigation Circuit 05/19/2021 $67.84
Type of Use: SF 1 ea Services or Feeders-200 05/19/2021 $100.70
Class of Work: ALT amps or less
Type of Const: 1 ea 12%State Surcharge- 05/19/2021 $26.46
Electrical
Occupancy Grp:
Total $246.94
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: �s%' � �/ - Permittee Signature:
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 Applicationtpi�®I gT( n,'
City of Tigard E C L..il �P E 9.�, iy/ ISZc+2! or, r t y,y, f .,�y /Q'7
ReceivedDate vj �V✓- Permit#:L`�,L(f (�C G /
III
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
1 Phone: 503.718.2439 Fax: 503.598.19601{p p r• '70L� Date/By: Related Permit#:
Inspection Line: 503.639.4175 ' Ready Date/By: Jar ® See Page 2 for
Ti G AR D Internet: www.tigard-or.gov Notified/Method. I( �" Supplemental Information
CITY OF it AR-
a."�.'',-Vi PL b '. PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition ❑ Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ElCommercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑ Master builder E Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:
10186 SW 69th Ave 100HP or more. ❑"A","E","1-2","1-3",
❑
City/State/ZIP: Tigard, OR 97223 ❑Health-care
or more facilities.residential units. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Caldwell Pool ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: Between Locust and Oak on 69th FEE SCHEDULE
Description I Vrv. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Oak Crest Lot#: 3 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.if or portion 33.92 1
DESCRIPTION OF WORK :1 Limited energy,residential
(with above sq.ft.) 75.00 2
Adding electrical equipment and accessories for a pool including: Limited energy,multi-family •
residential(with above sq.ft.) 75.00 2
Pump, filter, lighting, heater, and chlorinator. Homeowner to do work Renewable Energy ❑ See Page 2
N PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: Ryan Caldwell 200 amps or less , 1 100.70 100.70 2
Address: 10186 SW 69th Ave 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Tigard, OR 97223 601 amps to 1,000 amps 301.04 2
Phone: ( 503) 816-0062 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: rtcaldwell@gmail.com 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,le rent r exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Qf/ Date: April 9, 2021 401 amps to 599 amps 168.54 2
APPL CANT '.❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7 7.42 51.49 2
each branch circuit
Contact name: Ryan Caldwell B.Fee for branch circuits without
Address: 10186 SW 69th Ave service or feeder fee,first 56.18 2
branch circuit
City/State/ZiP: Tigard,OR 97223 Each add'I branch circuit 7.42 2
Phone: Fax: : ( Miscellaneous(service or feeder not included)
( 503) 816-0062 ) Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email: rtcaldwell@gmail.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 1 67.84 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ID See Page 2 2
Address: OW ,n panel,alteration,l or s extension. g
City/State/ZIP: t� 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
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no tee is 9000/hr
CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed(!5 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 220.48
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): Z,•4.(
Authorized ature:
TOTAL PERMIT FEE: Z44,914
/ This permit application expires if a permit is not obtained within 180
Print name: olf� Date: April 9, 2021 days after it has been accepted as complete.
7 * Number of inspections allowed per permit.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qtv. I Each I Total I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
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:
n 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
with OAR 918-309-0040) 552.26 2
❑ 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
specifically listed fl/2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter
Fee for each commercial system: $75.00
Number of inspections allowed per permit.
Page 1):
*
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n B• oiler Controls
n C• lock Systems
n D• ata Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
In Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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