Permit CITY OF TIGARD ELECTRICAL PERMIT
.1111
a>� COMMUNITY DEVELOPMENT Permit#: ELC2021-00338
T g G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/21/2021
Parcel: 2S 111 DA09400
Jurisdiction: Tigard
Site address: 8999 SW GRAVENSTEIN LN
Project: Steele Subdivision: APPLEWOOD PARK NO.3 Lot: 87
Project Description: (3)branch circuits for garage.
Contractor: OWNER Owner: STEELE, NATHAN R
8999 SW GRAVENSTEIN LN
PORTLAND, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 06/21/2021 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 06/21/2021 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 through 0 R 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: t1ti7�-t°' t.�i_-� Permittee Signature: ell/ A'C-./ ''f--71U,..1
// 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.
E- (21111121
Electrical Permit Applicati ECEIVED FOR OFFICE I SE ONLY
CityofTigard Received
/, ,�J / 7/
u 131SW Hall Blvd.,Tigard,OR 97223 JUN 1 4 2021 Plan Review
��/ �� Permit -�D'33
C Phone: 503.718.2439 Fax: 503.598."'' ' Date/By: Related Permit#:
T 11,,�1.I) Inspection Line: 503.639.4175 O r I I uNti(-' Ready Date/By: - Saris: ElSee Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISIC' Notified/Method: L//7ij' .. ley ( Supplemental Information
TYPE OF WORK j PLAN REVIEW
❑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 ❑Building over three stories.
CI Demolition El 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 ID 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: ❑Fire pump. ❑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: 8999 sw gravenstein In 100HPormore. ❑ `A","E","1-z","l-3",
City/State/ZIP: Tigard,OR 97224 ❑Six or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
0 Supply voltage for more than
Suitelbldg./apt.#: Project name: Branch circuits added to garage 0 Hazardous locations. 600 volts nominal.
❑Service or feeder 600 amps or more.
Cross street/directions to job site: SW Sattler St/Hall Blvd 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'1 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited ener .gy,residential 75.00 2
Two branch circuits added to garage and one existing (withabove,mt)
Limitedd energy,mullti-family
circuit updated with new electrical box and outlet. residential(with above sq.ft.) 75.00 2
PROPERTY OWNER ❑ TENANT Renewable Energy ID See Page 2
Services or feeders installation,alteration,and/or relocation
Name: Nathan Steele 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
8999 sw gravenstein In
401 amps to 600 amps 200.34 2
City/State/ZIP: Tigard,OR 97224 601 amps to 1,000 amps 301.04 2
Phone:(503) 707-1 81 8 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: steelenathan @gmail.com relocation
Owner installation:This installation is being made o property that I own which is not 200 amps or less 59.36 I
intended for sale,1 e nt, exchange,a • -447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: • ' Date: 6/14/2021 401 amps to 599 amps 168.54 2
Branch circuits—new,alteration,or extension,.er panel
[}a'APPLICANT ❑ CONTACT PERSON
A.Fee for branch circuits with
Business name: home owner 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 1 56.18 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 2 7.42 14.84 2
Miscellaneous(service or feeder not included)
Phone:
( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 lir min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lie.: specifically listed('/hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: 7? ..y
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it bas been accepted as complete.
* Number of inspections allowed per permit.
t.lB,utdiag\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(I I/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 Description Qty. Each I Total
3' Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ V• acuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n A• udio and Stereo Systems
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
n Instrumentation
• Intercom and Paging Systems
n Landscape Irrigation Control*
❑ M• edical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits/ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
Property Owner Statement
Regarding Construction Responsibilities
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))
This statement is required for residential building,electrical, mechanical, and plumbing permits.
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:
[ _ I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
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 I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. 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.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
/V4.41,1 a.K 5 lee, fe.
Print Name of Permit Applicant
4 /_ / 1 Le/-2 ,.., z, (
Si nature of Permit Applicant Date
Permit#:
' ;'. •
Address: S 9 414 5 i-/ 4 reLve-�ii&-► L.., • /.` - ' .
Issued by: _ Date:
This Copy for Permit Offices
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