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Permit IN CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2021-00381 Date Issued: 7/13/2021 Tr G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103CC13200 Jurisdiction: Site address: 12076 SW WHISTLER'S LOOP Project: Rockenstein Subdivision: Lot: Project Description: Adding(4)branch circuits to connect a generator transfer switch,new out door unit,and gas furnace reconnect. Contractor: BULLSEYE ELECTRIC Owner: EDWARD ROCKENSTEIN 3613 NE 64TH AVE 12076 SW WHISTLER'S LOOP VANCOUVER,WA 98661 TIGARD, OR 97223 PHONE: 360-260-4814 PHONE: 619-992-8974 FAX: 360-256-4542 FEES Quantity Description Date Amount 4 crt Branch Circuits wo/Purchase 07/13/2021 $78.44 Specifics: Service or Feeder 1 ea 12%State Surcharge- 07/13/2021 $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: Or gon law req es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through 52-0 090. may obtai oovv the rules direct ouestions to OUNC by calling 50 . 2.1987 or 1.800.332.223n344 �p Issued By: �'K� ..>� ���r, Permittee Signature: -'-d' ✓4r��,�� 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'N 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 Applicatio8ECEIVED i FOROUFL(.1L USE ONLY City of Tigard JUL 8 2021 Receives , ,��/ P , DalB i � amt _o `__.tr ' !Pli • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.19®lTY OF TIGARD DatdO : Related Permit u: Inspection Line: 503.639.4175 BUILDING QIVISlON Ready Date By: luris: 0 See Page 2 for 11t Al.I7 Internet: wwwtigard-or.gov Notified/Method: Supplemental Information TVPE OF WO.EIC PLAN REVIEW. 0 New construction 1 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 ❑Commercial/industrial ❑Accessory building less to ground or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder El Other: 0 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: i 2el la Sw L J At SVle rS LooP 100111'or more. ❑"A""E" "1.2" "1.3" City/State/ZIP: 'T' G ya-12,p 01e(O 1J d17 Z 2�J ['Six or more residential units. Recreational vehicle parks. 1�' ❑Health-care facilities. ❑ P Suite/bidg./apt.#: Project name: E. MI R b Roc f�i-Vf S}Qy 1s ❑Hazardous locations. ❑Supply voltage for more than CIService or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I s 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'l 500 sq.ft.or portion 33.92 I DESCRIPTION OF.WORK Limited energy,residential (with above sq.ft.) 75.00 2 Lo AvV2..C-Vivt Pc GI trl t1-FOrar i r4 JS-Ce-r S1tsl4-11a t t ) Q iA- limited energy,multi-family 75.00 2 hoof t-L 4 - ! ws V l .`l pry Re.( Zh n e- residential(with above sq.8.) PROPERTY OWNER 0 TENANT Renewable Energy ❑ See Paget Services or feeders Installationtalteration,and/or relocation Name: E�W NIVes <R(>C. (�N 5--E t N 200 amps or less 100.70 2 Address: I 7_0 9(p S W W Yu CAA€ S 1�.1x7 201 amps to 400 amps 133.56 2 i' 401 amps to 600 amps 200.34 2 City/State/ZIP: --0 60,XLl, © (7oN oil 7Z 3 601 amps to 1,000 amps 301.04 2 Phone:(to 19) 019 2-Q,t 114 Fax:( ) Over 1,000 amps or volts s 552.26 2 Email: N e � # y�.4- Temporary services or feeders installation,alteration,and/or �'.YO�� C' relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I 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 0 APPLICANT CONTACT PERSON Branch circuits-new,alteration,or extension,per panel % A.Fee for branch circuits with Business name: ----b})✓1 i��U El,Pt_'1"i.G above service or feeder fee, 7.42 2 C \ I' I_O V �r each branch branch circuits without service or Address: - 1..,,,17� N 6(.}'A` s` branch circuitfee fee,lust I 56.18 Von 2 City/State/ZIP: \.{(j-ty e_e>kA-x)-e-- �)4 ��iZ Le Each add'I branch circuit 3 7.42 2'j.,",(0 2 � Miscellaneous(service or feeder not included) Rhone:('>(d)) 2 Go- L.1 c IL( Fax: :(gip) 7 jL,.- i....I SL!y Each manufactured or modular — -�i dwelling,service and/or feeder a 67.84 2 Email: '��-t&tt�j @ tJ C Ei-1.1\S -ElectAA C-, Ct P\ Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 . Business name: lighting 67.84 2 13 v�11321�r� E l e.c rZc, Sign or outline Address: I N (D - a } Signal alteratio(s)n. or limited-energy ❑ See Page 2 2 3 y ..e..a-t panel,alteration.or extension. City/State/ZIP: U L UtA 1}2 t ` Each additional inspection over allowable in any of the above r 7 '/ Additional inspection(l hr min) 66.25/hr Phone:(34()) 2(0 0 - i4 e)14 Fax:(340) 2.7 C tP- 'f S7 Z Investigation(1 hr min) 90.00/hr t� Industrial plant(1 hr min) 78.18/hr Email: Pt-r►--i}-5 & �Ihi15EVE- E 'LC-1(-teI�t C6'1/� Inspections for which no fee is 90.00/hr lO rI 21 Q LA` -6 p L l 05051 specifically listed('/:hr min) CCB Lic.: DD C. 1 Electrical Lic.: t rv.Lia: -1 ELECTRICAL PERMIT PEES • Suprv.Electrician signature,required: i,„",..„/ Subtotal: 7 q d/ r Print name: R`1ract.-t- -9\1/4A.0 KI.,,,,,t,m„,1 Date: "`1-e.z I 0 Plan Review Required(25%of permit fee): kr f p State surcharge(12%of permit fee): q,a4 i TOTAL PERMIT FEE: Authorized signature: k ,fly i���.gs , � This permit application expires if a permit is not obtained within 180 Print name: 1-6 d 4zG IQ t Is on Date:7 S_2) days after it has been accepted as complete. 11 '' Number of inspections allowed per permit. I:\Building,Premite\ELC_PernitApp_ELR_ERE.doc Rev 06/172015 440-4615T(l I/OS/COM/WEB