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Permit 1111CITY OF TIGARDELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2021-00427 Date Issued: 8/10/2021 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135CA02200 Jurisdiction: Tigard Site address: 11405 SW 95TH AVE Project: Villarreal Subdivision: None Lot: None Project Description: Install 200 amp service panel. Contractor: OWNER Owner: VILLARREAL,VICTORIA L& VILLARREAL, MAURICIO S 11405 SW 95TH AVE TIGARD, OR 97223 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders-200 08/03/2021 $100.70 Specifics: amps or less 1 ea 12%State Surcharge- 08/03/2021 $12.08 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 throuah OAR 952-001-0090 You may obtain a coos of the rules or direct auestions to OUNC by callina 503.232.1987 or 1.800.332.2344. Issued By: /1014 Vc7,sc De•We.1G Permittee Signature: Orv14ppll..CGttLtO-Y1 OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE: Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC'N Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. RECEIVED -7 /Z' �; rical Permit Applicatio FOR OI F1( 1: 1 NU,()N1.1 JUL �� Received City of Tigard vf l 2V% Date/By: ��7� d Permit 7 ��y� 4 13125 SW Hall Blvd.,Tigard,OR 97223 �-+ Plan Review v[ Phone: 503.718.2439 Fax: 503.598.1 t$ OF T GARV Date/By: Related Permit#: T I G A R 1"> Inspection Line:g503.639..4175 3 U I LDI NG DIVISION Ready Date/By:¢//� �� turfs: ^ Supplemental pp a Page 2 for Internet: www.ti and-or. ov Notified/Metho�l. �yL/ �� Su lementalInformation TYPE OF WORK b tign- •/ '4 ' /&LAN REVIEW ❑New construction KLAddition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more 0 Building over three stories. ❑ 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. Ep 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. El 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 ,`0 5c4 95 L4 A(�L' ❑Addition of new motor load of system. !! Job#: Job site address: G� R yr 1 looxP or more. ❑"A","E","1-2","t-3", City/State/ZIP: T't AA ci ❑Six or more residential units. occupancy. �l r 2.' R. �� ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#•/iO-S4! Project name: 0 Hazardous locations. 0 SSupplyvly voltage formore than /� ❑Service or feeder 600 amps or more. al. Cross street/directions to job site: 61 R- E Il 1 &c FEE SCHEDULE lam' 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'l 500 sq.ft.or portion 33.92 1 DESCRIPTiON OF WORK Limited energy,residential _ _ (with above sq.ft.) 75.00 2 Vpf y p� '— �/ 4D; T('1 260 imps (� —cgt,4�,. Limited energy,multi-family /f t residential(with above sq.ft.) 75.00 2 LLtI LAC l�L i a i'� Renewable Energy 0 See Page 2 sp PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation Name: IkA !1l R LC t, IL )200 amps or less 100.70 2 «<< 't���`"`��� -) V (fit 201 amps to 400 amps 133.56 2 Address: / l %©� 5((� �f� r� U� l Q R U . � c7 3 401 amps to 1,600 amps amps 200.341 2 City/State/ZIP: '�' �'v� ) 601 amps to 1,000 301.04 2 Phone:01_1) '27/ ��.L( / 5" Fax:( ) Over 1,000 amps or volts 552.26 2 �{' l3' Temporary services or feeders installation,alteration,and/or Email: im a,r (-4-O — t.) t L 51 7 Aker) , catik 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, r exc nge 2' rding to ORS 447,449,670,and� 701. 201 amps to 400 amps 125.08 2 Owner signature: �� Dater ^ ,3'Z i 401 amps to 599 amps 168.54 2 APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit Contact name: B.Fee for branch circuits without Address: service or feeder fee,first 56.18 2 branch circuit City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax::( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: ill et jy.L} _LC., I I 7"4 t.t.20 • (Ok"s... Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: E-- w� Sign or outline lighting 67.84 2 Address: Signal circuit(s)or limited-energy ❑ See Page 2 2 panel,alteration,or extension. City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(I hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(I hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed(%z hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: /t971 ,72 Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): /,2 ; Q, Authorized signature: TOTAL PERMIT FEE: /4.2. 7P This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. t:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB 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. Of '..Z 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. A44.0v....a,.0 (\) ,.L.A__A.c2. -E-).1,_ Print Name of Permit Applicant Signature of Permit Applicant Date Permit#: EL('_2 Z! -C2OtiZ.7 410 Address: // yoS .5 0 `�S r9�/E '�'` ' Issued by: Date: if-1- This Copy for Permit Offices