Permit CITY OF TIGARD ELECTRICAL PERMIT
114
t COMMUNITY DEVELOPMENT Permit#: ELC2021-00389
Date Issued: 7/13/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S103CB02000
Jurisdiction: Tigard
Site address: 12220 SW JAMES ST
Project: Clegg Subdivision: None Lot: None
Project Description: (1)100 amp service to shop
Contractor: OWNER Owner: CLEGG, MARK D&MEGAN JONES
12220 SW JAMES ST
TIGARD, OR 97223
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 07/13/2021 $100.70
Specifics:
amps or less
1 ea 12%State Surcharge- 07/13/2021 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 throuoh.OAl 52 9_01 009p. You may obtain a coov of the rules or direct ouestions to OUNC by calling 503 232.1987 or 1.800.332.2344.
"L.4' ` '.vi=Y ,..- t` l / ( 'f / "'
Issued By:
- 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'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.
a
' 2k@,adt" •�,r' °dye? "...^u.N*^maa .
y,rt .. rN.,w , ? "+v ar r �
Y w:^ cs „ +g w L i s;ti'^'m'ik.;,prm:, ry' " , +ei r w m,v, ^sa...a xw :
9 k --'2'" rr, im' . '' ''; n t^"s ry .. , ,J! :t
a S a tsY`A a..aa xT .m� � e+ ',scs "�"-% °.^�.w.a. � �4 :.�i S.�Pa'3d� �;, � M;✓. a".a�,��vw�`pua- q#'d"A"a,� .�',
11 .;<fo. rr § a '; .§(s'u d ' • k.11,1t :' it rs r x �° ' "'4'' +3 �
a,,.,,. .,,„,,„'c � '�� dx�4.:E,.�fi:�7��t Lr :�. _� �"s '+T.�.s 1.'%.,
' E ss+mas,�� :.�,...,: tq� ad n st 3 ran
%, stt rse sv +i. � a+t� r )1,.! xfl.f.la ; t r
liti Rl p� gt��,ma :4 B e� 4.,.:,L '•1. 1 l
c t'g 'tr k5 sa e:;. ' r -. :a+*.- i .Sr„,,y r d' .4f,, s tx a,.
ds¢ °a v mi
'...de 4 e w t 5t .a a• . ski a a 1.d sm '*rF ..,1
t l 114,"1) t' nteE , r t* °9. .:w f Y a aar„m 2
ry�yyppt a. r a a
N91fiCdi3vlet'Ittttl:; S i a�i lnfr
11- - '< ARI ntttiatran
['3 (;lr Y '� d 1 -fit ss u � � .
t'' 'T tparr � ij s a,
L New construction ►g Addition/alteration/re lacernentr Poeasocheailrat irytsdsntr2� �
p apply- ofplans w-ecru cheesed)
LI1.)Cmo11Uon a Other: ❑Service or feeder 400 amps or more ❑Bulking wit!tyre dine,
< where the available fault current O'vfanna.and orratyards_
S' ,� V -S'SI 'S`lttI.CTLt + s o=:e exceeds IQOOp amps at 150 volts or 0 Floating,buildings.
El 1-and 2-family dwelling ❑Commercial/industrial XAccessory building l less to ground,or exceeds 14,00O D Commensal uu aggt a,te ni
�� Multi-family slaps for all other insiallaticns. buildings,
y ❑Master builder ❑Other .',�('ire pump. ❑installation of[ U v-,Of
JO SSTk-St+EI tit M t1 S171T!Tc ET} 1( (A3IQjs( ❑Emergency system. larger separately derived I
2 2'y 0 $ J \ , _ 0 Addition of'tew motor load oC system.
3ob----
occupancy
Joh site address. (, L C. W Ire +j+ S� lonripor more. ❑ a �. '1 °?
v , ID Six or.more residential units_
City/State/ZIP:r State/ZIP : "VLA i 7}�} +7� ❑gcc eat:onal�re'tic.e U
_ L G�{! -J D Health-care facilities. r
Suitclbidg./a�pL#: --� Irojecttlatrie: flHazardouslocations L0Stipp);.ioliagefr more than
�.. ��'� 664 sells ncnr3rrai
---- ---- ojeet ❑Service or feeder 600 amps or more.
TossDGtri lion g �
C strcetldircctions tojab site: I t G j Cj REE:�,GI# u„L
Iv. Each tuts!
New residential single-or multi-family dwelling unit-
Subdivision: Lot#: Includes attached garage. i
-- — 1,000 sq.ft.or less 168.54 ° 4 1
Tax mttp/Parcel li: Ea.add'I 500 sq.ft.or portion 33.42 1 i
�` DESEIYIS'TfOlY,O WORK - Limited energy,resrdenna) 75.00
(with above sq ft) �i
l tr-
,� , +�/ �IAllt.$ , � Ltmtted energy,multi-family ! 7500 2
��� (� L'_ ,..,/ residential iier above scLti_} =
„X�1 Renewable Energy [] See Page 2 J
PgOPS kT r;OWNEIt '„, u c ':;a[ TS?J.N. Ad Services or feeders installation,alteration,and/or relocation
-✓w. 200 amps or less / t
Name: VIA ( 201 amps to 400 amps 3356 I
AddTESS: �'�,Z„ - 4�� 401 amps to 600 amps 20034 -
C'ityiState/LIP: �{1 (�J��p_ �7e2 ? 6ot amps to t,o00 amps 3ai.o4 } -
,��• // " ""T� Over 1,000 amps or volts 55'26 • 2
Phone:,?v 3 }^ `rj Fax ( � ) 'Temporary services or feeders installation,alteration,andfor =.
�r ��r,� �q_ �LI _t_ relocation
amps
1 mail: e l7 l
Owner installation:This installation is being made on property that 1 own which is not 22001 am}s tor 4te0ns 1?�-36s 12
intended for laic, leas chat�o>according to ORS 447,4ate 670, T tnd o 2 401 amps to 599 amps bs 54 + 3 i
/�,l/�1r`°� Date:
t)wnc r stgDatureBranch circuits-new,alteration,or extension, ter pane 1
Q'-AR Plif ri.7.-,, —,,____,,::.,,,,,,,,,*,,,,_,,,,,,,,,,,,,,
Q=SON fAGT'.Pl RSO1V A.Fee for branch circuits aith
above servce or feeder fee, 7 42[Iusmessncnne: _ each branch circuit__ -- �B.Fee for branch circuats without
�- �• service or feeder fee,firstCotttact nantc. - - 56-18 2 ii _ ��..-- branch circuit , s
Addtcss: Each add'!branch circuit 1 1 7.42 i 2 i
(_ttyl9tate"LIP Miscellaneous(service or feeder not included)
}- _ _ It.a . :( } Each manufactured or modular /;7.84 2
I Phont::( ) �._.--- -- ` dwelling,service and'or!ceder Reconnect onlyb7.84 I, 2
t nail • , ,0,a " •' 'C1 ` '1 .1 't?ra tFli +73{ m S:�i:. Pump or imgation circle67.84 2'ta Y 6 a k; . * " 1N�° "i` '`-- < - Sign or outline lighting 67.84
ausint. nanlc. Signal aircuit(sl or limited-energy See Paget
.. _...� - �"- < panel,alteration,or extension.
� Addr G __- »- - Each additional inspection over allowable in any of the above i
-"_ _ ,� - Additional iti pectian(1 hr tuna) 56 25l hr
)„sty Stater'I.IP:
_,,,�----^-=-'"":-'_....� ) 90.00/hr
Pax:{ Investigation(I bnnin)
done:( Industrial plant(1 hr min) 78.18,r hr .--
1 l,ittail -- -- -.--- Inspections far which no fee is 9QGOt hr
- Electrical Lie. Suprv. Lie.: speemcalh iastt,et(i In min) _
1Ct'f3Lic - - - -
. s SF ILCALi:PS EIT:FEES ..
[ ruPr t teetrician signature...required: Subtotal:
Pair t nrnuefY Date: ❑Plan Review Required(25%of permit fee)-
t"
State surcharge(12%of permit fee) 1 `
'B Au orl/ed.Signature; farm,PERMI l'f EF,. 1 1
r-- --- ----- -----_ _ — 1 This permit application expires if a permit is not obtained within ISO
,•„d i t,. Print name. Date: j days after it has been accepted as complete.
qt '',4 a�`:. -:'x etas,�m �' „x� 'At-, A ,-a..
to .. t*ti ,.:..� xnr+���� '3 t' �,"'':'t i.% � ' `.."'t-.�� � ""-�" }'.' " f-fr.f '4x .y, :.' bk.?-w
Property Owner Statement
Regarding Construction Responsibilities 7 . .
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued, (ORS 701,325 (2))
r„ This statement is required for residential building, electrical,mechanical, and plumbing permits.
t licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
l 1 I own, reside in, or will reside in the completed structure and my general contractor is:
NameCCB# Expiration Date
t
1 i I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
' , I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If 1 hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Beard. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
—`"t nova roadand understand the Information Notice to Homeownersstatement Aboutistrue Construction Responsibilities,
and l hereby certify that the information on this homeowner an accurate.
jet, t
t'rint Name of pern7r1.4Piican 1
‘14- /7- 1, ___
Signature Permit p ppl�can Date
1
i, Bye` to l , - _ - ., 44. t 3L`
a
,�� �j ( Issued by: "_` f 7 o Date
,'.l 'r - -
Dianna Ornelas
From: #Building Permit Technicians
Sent: Monday,July 12, 2021 4:27 PM
To: MC
Subject: ELC2021-00389 - Clegg - 12220 SW James St
Attachments: ELC2021-00389.pdf
Hello Mark,
This permit is ready to issue and the balance due is$112.78 (see attached invoice).
The fees can be paid online at https://aca-prod.accela.com/TIGARD/Welcome.aspx by searching for the permit record
number ELC2021-00389 under the Building tab. Payment can be made by'card' for a 3%service fee or select the 'check'
payment option and there is no service fee.
Please email the permit technicians at TigardBuildingPermits@tgard-or.gov once the fees are paid so that we can
issue the permit and email a copy.
Thank you.
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
1