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Permit Support Document Electrical Permit Application FOR OFFICE USE ONLY City of Tigard Received DateBv: Permit P. • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ' 2 Phone: 503.718.2439 Fax: 503.598. v t DateBy Related Permit#: Inspection Line: 503.639.4175 J299' N� V Ready Date/By:: loris: El El See Page 2 for '1IGAR D Internet: www.tigard-or.gov FH3 Notified/Method Supplemental Information ❑x 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 ❑Other: where the available fault current 0 Marinas and boatyards. ` CATEGORY OF CONSTRUCTION '` exceeds 10,000 amps at 150 volts or ❑floating buildings. X❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings ❑Multi-family ❑Master builder ❑Other: exceeds pump. buildings of 150 KVA or 0 Emergency system larger separately derived ❑Addition of new motor load of system. Job#: 2999 Job site address:13097 SW Foran Hills Ct. IOOHP or more ❑"A","E^,"t-2", '1-3", City/State/ZIP: Tigard, OR 97224 Suite/bldg./apt.#: I Project name: Foran Hills 0 Six or more residential units. occupancy ❑Health-care facilities. 0 Recreational vehicle parks. ❑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: FEE SCHEDULE Description I City. I Each Total New residential single-or multi-family dwelling unit. Subdivision: Foran Hills I Lot#: 3 I Includes attached garage. 1,000 sqft.or less 2 168 54 4 Tax map/parcel 4: Ea.add'l 500 sq.ft.or portion 1 33 92 IrIIIMPIIIP DESCRIPTION OF WORK Limited energy,residential 75.00 2 New, single family residence (with above so.ft.) Limited energy,multi-family 75.00 2 Permit#: MST2021-178 residential(with above sq.ft.) al PROPERTY';,r I Renewable Energy 0 See Page 2 I Services or feeders installation,alteration,and/or relocation Name: Stone Bridge Homes NW, LLC 200 amps or less _ 100.70 Address:4230 Galewood St. Suite#100 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: Lake Oswego, OR 97035 601 amps to 1,000 amps __ 30104 2 Phone:( 503)387-7577 I Fax:( 1 I Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: portlandpermits@stonebridgehomesnw.com I relocation Owner installation: This installation is being made on property that I own which is not 200 amps or less 59.36 I 1 intended for sale, lease,rent,or exchange,according to ORS 447,449,670,and 701. 1201 amps to 400 amps 125.08 I 2 Owner signature: Date: 1401 amps to 599 amps 168 54 2 ® APPLICANT AMR ❑ CONTACT PERSON I Branch circuits—new,alteration,or extension,per panel A Fee for branch circuits with Business name: Stone Bridge Homes NW, LLC above service or feeder fee, 7.42 2 each branch circuit Contact name: Permit Tech B.Fee for branch circuits without Address: 4230 Galewood St. Suite#100 service or fefee,first branch circuit 56.18 2 t City/State/ZIP: Lake Oswego, OR 97035 Each add'I branch circuit 7.42 12 Miscellaneous(service or feeder not included) Phone:( 503)387-7577 I Fax: : ( ) I Each manufactured or modular 6784 2 dwelling,service and/or feeder Email: portlandpermits©stonebridgehomesnw.com Reconnect only 6784 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: Garner Electric Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy ❑ See Page 2 2 Address: 2920 SE Brookwood Ave. Suite#A panel,alteration,or extension City/State/ZIP: Hillsboro, OR 97123 I Each additional inspection over allowable in any of the above I Additional inspection(I hr min) 66.25/hr Phone:( 503) 648-4552 I Fax:( ) I Investigation(1 hr min) 90.00/hr Email: chelsea@garnerelectric.com Industrial plant(I hr mm) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: 1211591 I Electrical Lie.: 24-305C I Suprv.Lie.: 3707S specifically listed(/2 hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: 4fi7;:, l�v �CfJ tizr Subtotal: Print name: Charles Garner I Date: 7-22-2021 I ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: ��QiyLCL ,g%4 TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Tiana Rudolf I Date: 7-22-2021 days after it has been accepted as complete. * Number of inspections allowed per permit I:\Building\Permits'iELC_PermitApp_ECR_ERE doc Ree 06/17/2015 440-4615TO 1/05/COM/WEB