Permit 411 INCITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2021-00301
Date Issued:
T(G A l2>7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1S125DD09200
Jurisdiction: Tigard
Site address: 9670 SW VENTURA CT
Project: WILLIAMS Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 100
Project Description: (1)feeder and(25)branch circuits for remodel.
Contractor: CHARGED ELECTRIC LLC Owner: WILLIAMS,THOMAS JUSTIN
12175 SW SUMMER CREST DR 9670 SW VENTURA CT
TIGARD, OR 97223 TIGARD, OR 97223
PHONE:
PHONE: 503-380-4364
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 06/17/2021 $100.70
Specifics: amps or less
25 crt Branch Circuits w/Purchase 06/17/2021 $185.50
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea Investigation Fee 06/17/2021 $90.00
1 ea Investigation 12%State 06/17/2021 $10.80
Type of Const: Surcharge
Occupancy Grp:
Total $387.00
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 .0 to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR ';-001-0 . Y' may obtai copy e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: /` /.,- Permittee Signature: 5 -' ` - C'
..
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 Application
City of Tigard ReceivedDate/By: r/ ,i 47- Permit#: 22_71 .6036 '
13125 SW Hall Blvd.,Tigard,OR 972RECEIVED Plan Review
Related Permit#
Phone: 503.718.2439 Fax: 503.598. Date/By: : 52I-At c.,u
Inspection Line: 503.639.4175 Ready Date/By: furls: 66 See Page 2 for !
TIGARD Internet: www.tigard-or.gov _2021 Notified/Method: - V Supplemental Information
WiLl
TYPE OF WORK PLAN REVIEW
❑New construction Addition/alteratio ti t`f IGAlib 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.
❑Demolition Other: BUY DING DIVISION where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
54 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑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: CI(3-40 S,j\i 4's Jt L..1-, 100HP or more. ❑"A","E","t-2","t-3",
❑Six or more residential units. occupancy.
City/State/ZIP: ‘/� J! i 0 p 1 1Zli17 0 Health-care facilities. ElRecreational vehicle parks.
Suite/bldg./apt.#: Project name: W,/1 1 0 Hazardous locations. ❑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 Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
1 k (with above sq.ft.) 75.00 2
it-'�dl� hl�v� tl � lf"► ( � N�� Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
'7 Name: _„-\ j �tilI'ems 200 amps or less 100.70 .70a 2
Address: n9' ^*✓ 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: 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
PPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: C 1..„hrt , J C `k/r 1 L Z,L (, above service or feeder fee, `'I) /���l
►ly each branch circuit 7.42 I✓V 2
Contact name: S 1,�, (l(q�hi ( 1 B.Fee for branch circuits without
!/�_ 11 ` service or feeder fee,first 56.18 2
Address: t Z l.F 7 S v.� Su11#\W✓ Lrl, `J r1 branch circuit
City/State/ZIP: _( ;t j ®re el 1.ZZ3 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( V 3 S®e 4-5 G4 Fax::( ) Each manufactured or modular 67.84 2
c+ t dwelling,service and/or feeder
Email:
�tuoyJt Ie L4(f i CE.,e k a I,C S ilk- Reconnect only 67.84 2
f/ CONTRACTOR Pump or irrigation circle 67.84 2
Business name: C/ h 1=E �[`l"r,f t c Ci Sign or outline lighting 67.84 2
G Signal circuit(s)or limited-energy 0 See Page 2 2
Address: (Z(1 C 5 %tP ih'l r lL,- Lbw r t panel,alteration,or extension.
City/State/ZIP: -1 trt ®e., Ct` -7 L Each additional inspection over allowable in any of the above
11 Additional inspection(1 hr thin) 66.25/hr
Phone:( Q'1)" 80 4 3 hat Fax:( ) Investigation(I hr min) 90.00/hr
, l Industrial plant(1 hr min) 78.18/hr
Email:
�,GLG\.r-5/Jt l eof✓tLe_ l t_O Inspections for which no fee is
/ specifically listed 0hr min) 90.00/hr
CCB Lic.: 1 ej it 1y-5 Electrical Lic.: `;S� Suprv.Lie.:SS-93
�,t ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: s%�� Subtotal: .
Print name: 1 w_. ,ti h I( Date: 57757 .„1 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 3 y.37
Authorized signature: TOTAL PERMIT FEE: 3).-0 :j 11
This permit application expires if a permit is not obtained within 180
Print name: 5,E 6,4,\ re 40. d (I Date:'c/x cll.,` days after it has been accepted as complete.
* Number of inspections allowed per permit. !� a
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