Permit CITY OF TIGARD ELECTRICAL PERMIT
'. COMMUNITY DEVELOPMENT Permit#: ELC2021-00176
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 4/8/2021
TIGARD g Parcel: 2S114AC01100
Jurisdiction: Tigard
Site address: 9118 SW WAVERLY DR
Project: Engen Subdivision: WAVERLY ESTATES Lot: 44
Project Description: Kitchen/Living room renovation
Contractor: OWNER Owner: ENGEN, MATTHEW P&JESSICA L
9118 SW WAVERLY DR
TIGARD, OR 97224
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo/Purchase 04/06/2021 $78.44
Specifics: Service or Feeder
1 ea 12%State Surcharge- 04/06/2021 $9.41
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 throug,[t,OOAA,RR 9152-001-0090. You may obtain a of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ``/ 1\ Permittee Signature: Or\ CA VV.)
"'lVV/•" 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.
15-y0(2,
Electrical Permit Applicatipt C e I``E
��C C V Receivedei/ �r9y�- ,/4
City of Tigard7 �t 2O� Permit#: GC/!-� «t! ( tC
13125 SW Hall Blvd.,Tigard,OR 97223
g AA Date/By:
Plan Rev
Phone: 503.718.2439 Fax: 503.598.19fiBPR 2021 Date Review Related Permit#:
Inspectionterne: Line: a d-or.g4175 Ready Date rho,1'�, _ �v ri See Page 2 for
T I G A It U Internet: wxvw.tigard-ocgov ITY OF TIGARD Notified/Methoda +�3�C�jLArte. Supplemental tnformatiou
TYPE OF itole f)!NU DIVISION PLAN REVIEW
El 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 stones.
❑Demolition 0 Other: where the availabk fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
NI1-and 2-family dwelling ❑Commercial/industrial ElAccessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: q II et Sb,1 l,,j Poi lz R L`/ t 100HP or more. ❑"A' 'E^, `l-2","t-3^,
City/State/ZEP: T I G Ar t_r U R p 22 L ❑Six or more residential units. occupancy.Recreational
1 I ( ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: SW 9 2"or.' FEE SCHEDULE
`_ 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
DESCRIPTION OF WORK Limited energ
y,residential 75.00 2
11 (with above sq.ft.)
K FT CAAGI4 1.1 V 1 N 4- Roar,. fa et,'OSiATi pN Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Pi PROPERTY OWNER 0 TENANT Services or feeders Installation,alteration,and/or relocation
Name: pi)AA-- L r..1 G.is rJ 200 amps or less 100.70 2
Address: 0‘‘‘t sw t.J fs J Qi,y 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: -1-i (sn,9._(' 02 et 1)'_1-1-1 601 amps to 1,000 amps 301.04 2
Phone:(503) 3 1'S 3916 I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: M its r4 GE..-i e. Ir2J u 1-,,-(2, C.ty relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 t
intended for sale,lease rent,or exchange,according to ORS 447,449,670, 201 amps to 400 amps 125.08 2
Owner signature: Date: y 1 2,1 401 amps to 599 amps 168.54 2
0 APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: 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 3 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
Email: dwelling,service and/or feeder
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 ❑ See 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(1 hr min) 78.18/hr
Email:
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv. Lie.: specifically listed(Vs hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 9$,HH
Print name: Date: 0 Plan Review Required(25%of permit fee): —
A State surcharge(12%of permit fee): Ci,XI
Authorized signature: / "` TOTAL PERMIT FEE: in to
This permit application expires if a permit is not obtained within 180
Print name: m(k'Sr f i G 1:tJ Date: y f 112.1 days after it has been accepted as complete.
r _ _1 I * Number of inspections allowed per permit.
Ii/BuildingIPermits1ELC_PennitAp ELR_ERE.doc Rev 06/17/2015 440.4615T(II/05'COM/WEB