Permit CITY OF TIGARD ELECTRICAL PERMIT
111
' COMMUNITY DEVELOPMENT Permit#: ELC2021-00429
Date Issued: 8/10/2021
T FGA RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111CA11100
Jurisdiction: Tigard
Site address: 9564 SW SATTLER ST
Project: Freeman Subdivision: LAKESIDE PLACE Lot: 2
Project Description: Add(1) 100 amp sub-panel and(3)branch circuits for garage outlets and light.
Contractor: OWNER Owner: FREEMAN, TYLER EVAN
GUFFEY, DEBORAH JILL
9564 SW SATTLER ST
TIGARD, OR 97224
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 08/07/2021 $100.70
Specifics:
amps or less
3 crt Branch Circuits w/Purchase 08/07/2021 $22.26
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 08/07/2021 $14.76
Type of Const: Electrical
Occupancy Grp:
Total $137.72
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 OAR 952-001-0090. You may obtain a coo,/of the rules or direct auestions to OUNC by callina 503.232.1987 or 1.800.332.2344,
Issued By: Holly Wiwi/De/Wage Permittee Signature: 0 kV74 ppliCa turn
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.
— . L
Electrical Permit Application FOR OF\.It I I .l.0\1.1
City ()f Tigard Received
�� ea...... Permit(rE,!! 2 i.j p
III .. 13125 S1A Hall Blvd..T tga d,OR c E iv E Plan Re. / / l r G)2--"ao /
$ Plume 503.718.2439 Fax $03. Ltate/By_ Related Permit x
IaspeCtian Line 503,639:4175 Ready Date lly p4 /" lw 0 See Page 2 fur
t ii %is(` r e n, eyra�9 .3 ��
Interne( Www'ti�"an)-+n ;7r't r � 8 >5if� NoutiedMlHfuxi`' Supplemental Information
I 1 I t it r }i _ _.__ _-._. , PLAN Y REVIEW
N. i`(li1'1T,lcllt)n ..._._. __ \.lelttl,rt hi..c ebc.tw all that.tp; ,I'.ul,rrul 2 r,l pht.v.iteo,.che..kedi
Ut ❑Set tee or feeder 4t10 amps or more ❑building ro.er three stone,
I yCtrialiliitrl l){)tit »here the available fault current ❑Marinas and boatyards
CA1"EGOIES t)r r .,,,..i lit f r,I'°,, exceeds 10,000 amps at ISO volts or ❑Floating huddmgs
® 1-and -lamih_ tin,Olin!: ❑C olnuiele osi tneitl it trsi yrrc;,i t, butt tin less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations buildings
0 Multi-tart)il' 0 Master builder 0 Other: ❑Fire pump ❑Installation of 150 KVA or
JOB SIT ENFOELVIATION AND;L(K'.AT7plt 0 Emergency system larger separately derived
0 Addition of new motor load of system
.Loh a•: Job site address. AS(e4 Sw S•.K'lu/` ' 10014P or more ❑"A'."E 1_z "1-3
Cit1'/State/?IP: °1INI 4• r aX q(7.X7,y CI Srx or more residential ants Q Recoccreational vehicle parks
Q Health-care facilities
Suitefiidg_iapt.a: —Pmject name: ❑Hazardous locations 0 Supply voltage for more than
0 Service or feeder 600 amps ur more 600 volts nominal
Cross street directions to job site. FEE SCHEDULE
Dncriptio0 r Qo. I t:at* f -total 1 •
New residential single-or multi-family dwelling unit.
Subdivision: 1,01 Includes attached garage.
- 1,000 sq ft or less 168.54 4
lax tnall`I33rCe1 1,
_ _ la add')500 sq ft or portion 33 92 I
___. DESCRIPTION OF WORK - Limited energy,residential 75 Ofi 2
(with above sq ft)
AGL k7Cl A Ste' '"- 0+r' gP"tummy, Limped energy,multi-family 75 00 2
} AO ' 4+(A.*' ‘4 4'4 (r okoi'c s 1 cAmtvs, i'v tyw44 residential(with above sq fl)
- - PROPERTY OWNER _ Q 'FF.:NANT .®^ Renewable Energy O See Page 2
FigServices or feeders installation,alteration,and/or relocation
N,inie ice t„- �rut.,,svk I 200 amps or less 1 100 70 2
1 201 amps to 400 amps 133 56 2
Address' 411 5 fe'i Sve So.4+1sar S-
401 amps to 600 amps 200 34 2
City/State ZIP. i:,y , OM 00a'rx4 601 amps to 1,(X)0 amps 301 04 2
Phone:{yOxs} l:72 (et'ye]„ Fay:( )
Over 1,000 amps or volts 552 26 2
Temporary services or feeders installation,alteration,and/or
I, I''mai1' } tic -: c rC4 sv...,1'b e,,- i1ir•►as:1-corn relocation
? Owner installation: 1"rti'in".l:tli::ara'ia is being made on property that I own which is not 200 amps or less 59 36
' tlltctstic,1 for tat, . '.Ir)gc. . tr,i ing to ORS 447,449.670,and 701. 201 amps to 400 amps 125 08 2
} } ;r',,r !, •.. ._-,,..._.. Date' 7 213-pC 1 401 amps to 599 amps 168 54 2
j -i-- - Branch circuits-new,alteration,or extension,Per panel
l...41'9'/ t� 3". ....:...._..,. j_ . ❑ {:'QIti TAL"i` PERSON -
A Fee for branch circuits with
above service or feeder fee, 2, .,42
each branch circuit
B Fee for branch circuits without
,. _ ............._._-......._..,....-..___..-.:........ service or feeder fee.first
branch circuit 56 18
Each adill branch circuit 1 7 42 2
/.i.. -- Miscellaneous(service or feeder not included)
fI ax: :( ) Each manufactured or modular 67 84 ,
_....,.."_- dwelling.service and;or feeder
rrth};. Reconnect only 67 83
I"a
(dSIbiA(7( 1t r/ rF /, , . ' Pump
or irrigation cirlei..,_ ... _ - _uM_ o 67 84
Sign or outline lighting 67 84
Signal circuit(s)or limited-energy
rI '" panel,alteration,or extension ❑ See Page 2
Each additional inspection over allowable in am of the*host
_.....:............................_......,,._._.._.._._ __... .._...__. Additional inspection(1 hr min) 66 25f fir
r' '.,.. r I I ax'( ) Investigation(1 hr min) 90(X)i hr
Industrial plant(I hr min) 78 18/hr
Inspections for which no tee is 9i1 p1) tit
I ' r r I tt 1 it. siulsr ti I ic.: s tficalls listedl'r=he min)
sr ` itMiT FEES
„1'i1„ As:r,iir•, rS. Subtotal '
._........ ..... . ._...- ....__.-.._.4.--...-.._...-...._
Date: - 0 Plan Review Required(25%of permit fie) ���
_.... ____._..___ __- .__-- State surcharge(12%of permit fee).
TOTAL.PERMIT FEE /,3�' L?
Thispermit■ licatioo es ires if a L
•"""�"•�^-""-• -- pP P permit is not obtained within ISO
Date days after it has beta accepted as complete.
. ._.._- - • Number of inspections allowed per permit
r, r.,rr y..+./ t r' :. %: Sac 46t`~1rt tNStCObUN'CB
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
FiErsliwNil NI.WORK ONI Y:
1 FEE SCHEDULE
j lath I loial
Fee for all residential steins combined: $75.00
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100 70 2
5 01 to 15 kva 133 56 2
E A• udio and Stereo Systems* 15011025 kva 2(10 34 2
Wind generation systems in excess of 25 kva:
0 Burglar Alarm 25 01 to 50 kva 301 04 2
50 01 to 100 kva 552 26 2
E3 Garage Door Opener*
>100 kva(fee in accordance
552 26 2
with OAR 911t-309-0040)
Ej H• eating.Ventilation and Air Conditioning
Solar generation systems in excess of 25 kva:
stem*
Each additional kva over 25 7 42 3
E3 Vacuum Ss terns* >100 kva-no additional charge 0 0 3
Each additional inspection over allowable in any of the above:
Each additional inspection is
LO Other: 66 25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is
90.00/hr
s.-ificall listed Y2 hr min
ri"OMNIERCIAI.,WORK.ONLY:
Subtotal(Enter on Page I):
Fee for each commercial system: 575.00
• Number of inspections allowed per permit
SEL OAR 918-309-0000)
Check Type of Work Involved:
0 Audio and Stereo Systems
Boiler Controls
E Clock Systems
El Data Telecommunication Installation
O F• ire Alarm Installation
ion
'',Vdiffill14;•11,0%:eAPOLA
Paging Systems
gation Control*
scape Lighting*
naling
stems:
allured for an
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
X 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.
T„�tty. �%1Gh �rGC VIL. l
Print Name of Permit Applicant
7 °1-21
Si ature of Permit Applicant Date
Permit#: L C ZO 2f ifa)-J
Address: y:SG y Stv -574 S7
Issued by: Date: •��'
This Copy for Permit Offices
Information Notice to Owners About
Construction Responsibilities
(ORS 701.325 (3))
Homeowners acting as their own general contractors to construct a new home
or make a substantial improvement to an existing structure,can prevent many problems
by being aware of the following responsibilities:
• Homeowners who use labor provided by workers not licensed by the Construction Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
• Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages
at the time employees are paid. You will be liable for the tax payments even if you don't actually
withhold the tax from your employees. For more information, call the Department of Revenue at
503-378-4988.
• Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information, call the Oregon Employment
Department at 503-947-1488.
• Oregon's Business Identification Number(BIN): is a combined number for both Oregon
Withholding and Unemployment Insurance Tax. To file for a BIN, go online to the Oregon Business
Registry. For questions, call 503-945-8091.
• Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain
Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs
if one of your workers is injured on the job. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 800-452-0288.
• Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from
employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax.
For a Federal EIN number, go online to wwv'irs gov.
Other Responsibilities of Homeowners:
• Code Compliance:As the permit holder for a construction project, the homeowner is responsible
for notifying building officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
• Property Damage and Liability Insurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensation Insurance.
• Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough-in and finish trades.
CONSTRUCTION CONTRACTORS BOARD
PO Box 14140, Salem,OR 97309-5052
Telephone:503-378-4621 —Fax: 503-373-2007
Website Address:wwvj.Qfegon_gov/ccb
f/property_owner adopted 9-2016 This Copy for Permit