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Permit
CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2021 00411 Date Issued: 8/5/2021 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102DC00400 Jurisdiction: Tigard Site address: 9265 SW EDGEWOOD ST Project: Blauer Subdivision: EDGEWOOD Lot: 16 Project Description: (1)200 amp or less service and(5)branch circuits. Contractor: OWNER Owner: BLAUER, MARC 9265 SW EDGEWOOD ST 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 5 crt Branch Circuits w/Purchase 08/03/2021 $37.10 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 08/03/2021 $16.54 Type of Const: Electrical Occupancy Grp: Total $154.34 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 coov of the rules or direct auestions to OUNC by callina 503.232.1987 or 1.800.332.2344. Issued By: fial2y Vcmi De/Wage Permittee Signature: owAppU.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'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. Ige Is Electrical Permit Applicatio City of Tigard DECEIVE ' DReceive ate/By: 7 .42 2 D Permit#:6� Z I '0011I/ u 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie / 1 C1/ 1111 li Phone: 503.718.2439 JUL 1 5 2021 Date/By: Related Permit#: Email: TigardBuildingPermits@Tigard-or. o Ready Date/By: tuns: See Page 2 for 1 I G A R D inspection Line: 503.639.4175 IntenCI w�>itg iiGhltd Notified/Method:y 2 21 i Supplemental Information TYPE OF45illiDINEDMS101" 6-77,'Ill 1 y,.3/LCj 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 0 Building over three stories. 0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ia1-and 2-family dwelling ❑Commercial/industrial El Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 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: 'Z GI:; S LA) a[7(r A*,p I00HP or more. ❑"A","E","1-2","l-3", City/State/ZIP: occupancy. �/n� Six or more residential units. P Y. ty �� ( 2`J F 22 0 ❑Recreational vehicle parks. Health-care facilities. Suite/bldg./apt.#: Project name: 13Iat t_ v 2.,Q S d-e rx. 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: 0` c' © N1� �A FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. p ) \ n pC. 11 Cy 0 0 t ;Ct a ^ 1,000 sq.ft.or less 168.54 4 Tax map/parcel arcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential � � J r f / y (with above sq.ft.) 75.00 2 V" 1 ! 111 rD ji- / 31 o vAi ot c (1 ' I ' u t t Limited energy,multi-family - p116 V� �`11 t SI residential(with above sq.ft.) 75.00 2 // / Renewable Energy 0 See Page 2 ROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less / 100.70 f co,70 2 201 amps to 400 amps 133.56 2 Address: /Z 6 5" ,, E P 6-- W®c�j S T� 401 amps to 600 amps 200.34 2 City/State/ZIP: i (37'�1 �t) C) p_ -(p"T jZ_3 601 amps to 1,000 amps 301.04 2 Phone:(953) q 5-1 - 061 Co Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: 1 a S 1 S C b /12 p? a . e.. r1 relocation Owner installation:This installation is being made oil property that I own which is not 200 amps or less 59.36 1 intended for sale,\lease,,rent,or exch:'tT� ccor• to ORS 447,449,670,and 7 1. 201 amps to 400 amps 125.08 2 Owner signature: ._/ 6:A,,... ,, _ Date: —7(1. 'IRO 401 amps to 599 amps 168.54 2 Branch circuits—new,alteration,or extension,per panel . APPLICANT ,CONTACT PERSON A.Fee for branch circuits with �- Business name: above service or feeder fee, r 7.42 2 16 2 II- each branch circuit ,--/ J Contact name: SA M E- Ii S A 6 Q u " B.Fee for branch circuits without Address: service or feeder fee,first ��9/�56.18 N 2 _ branch circuit City/State/ZIP: VIl " , C lc iV i ( ' -44.- Each add'I branch circuit /04 7.42 ligitetst 2 Miscellaneous(service or feeder not included) ^ Phone:( ) k J ` -6 `'% -_ (90 2 C6 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: L.{) !v 0 Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: Fe/`el 0 4 rt Cry I.)I ri .s T_ w panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Investigation(1 hr min) 90.00/hr Industrial plant(1 hr min) 78.18/hr Email: Inspections for which no fee is hr I /� r U CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed(/hr min) 90.00/ ' ' ELECTRICAL PERMI'i' FEES I/� �.'R�` Suprv.Electrician signature,required: Subtotal: ��,g��,,�('' Print name: Date: 0 Plan Review Required(25%of permit fee): . 2f State surcharge(12%of permit fee): `e ~ ' Authorized signature: 7/i .r )2-/ TOTAL PERMIT FEE: f',", ., 0 c p I This permit application expires if a permit is not obtain within 180 Print name: \4� v`""� e Date: days after it has been accepted as complete.5' _M' h * Number of inspections allowed per permit. J t I:iBuilding\Pamirs\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 440-4615T(11/05/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 Description 1 Qty. 1 Each I Total Fee for all residential systems 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 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: n Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >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 ❑ Vacuum 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(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(%z hr min) COMMERCIAL WORK ONLY: ELECTRICAL,PERMIT FEES r Subtotal(Enter on Page I): Fee for each commercial system: $75.00 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems n Data Telecommunication Installation n F• ire Alarm Installation ❑ HVAC n Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* n M• edical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ O• ther: 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 10/26/2017