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Permit I _ CITY OF TIGARD ELECTRICAL PERMIT ''1 COMMUNITY DEVELOPMENT Permit#: ELC2021-00307 Date Issued: 8/4/2021 TtGARI) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S114BB16300 Jurisdiction: Tigard Site address: 16236 SW 103RD AVE Project: Heye Subdivision: RIVERVIEW ESTATES Lot: 9 Project Description: Hot tub install and outlet for lights Contractor: OWNER Owner: HEYE,ASER B TIEL-HEYE, KIMBERLY E 16236 SW 103RD AVE TIGARD, OR 97224 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 2 crt Branch Circuits wo/Purchase 06/04/2021 $63.60 Specifics: Service or Feeder 1 ea 12%State Surcharge- 06/04/2021 $7.63 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $71.23 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 throuaahO OAR 952-001-0090. You may obtain a coov of the rules or direct questions to OUNC by callino 503.232.1987 or 1.800.332.2344. Issued By: Holly VGtivLDP WagePermittee Signature: 0YVApptf cat ort 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. Electrical Permit Application FOR OFFICE LSE ONIX `/ City of Tigard `� ! teeiByy: O6/t?3/Jc,12/ permit If:EL-C-202/-©c 3e9 / 114 't 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review III. Phone: 503.718.2439 Fax: 503.598.1961AY 2 5 70VV Date/By: Related Permit N: Inspection Line: 503.639.4175 Ready Date/By:pGf �C Jaris' RI See Page 2 for 1'IGARI) Internet: www.tigard-or.gov CITY OF TIGARD Notitied/Method 3/ Supplemental information YPE OF WOWING DIVISION! PLAN REVIEW • ❑New construction Addition/alteration/replacement Please check all that apply(submit a sets of plans w/items checked): 0 Service or feeder 400 amps or more 0 Building over three stories, ❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards. �,/ CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. Ct l-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricuhural amps for all other installations. buildings. ❑Multi-family 0 Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived -- U Addition of new motor load of system. Job#: Job site address: - 100HP or more. ' ❑"A""E" "I-2" "1-s" City/State/ZIP: ' ' ' y r * ❑Six or more residential units. 0o creational vehicle arks. ElHealth-care facilities. p Suite/bldg.apt.#: Project name: ❑Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE _ Description r ii [" Each I Total 1 • New residential single-or multi-family dwelling unit. Subdivision: Lot#: includes attached garage. Tax map/parcel#: 1,000 sq.tl.or less I 168.54 4 Ea.add'1500 sq,ft.or portion 33.92 I DESCRIPTION;OF WORK ' '. Limited energy,residential 75.00 2 (with above sq;R.) Limited energy,multi-family 75.00 2 residential(with above sq,ft.) Renewable Energy 0 See Page 2 ,P!RQPERTY OWNER -I`' 0 TENANT Services or feeders installation,alteration,and/or relocation Name: �j 200 amps or less 100.70 2 Address: 1r SApt As ne6 sir*" 11t1. 201 amps to 4W 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: ) 41 4 Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner a t It. i sta on in ma eon property that I own which is not 200 amps or less 59.36 1 intended for sale,le re or ch g cording to ORS 447,449,670, (IL 201 amps to 400 amps 125.08 2 Owner signature: Date: _ 401 amps to 599 amps 168.54 2 0 APPLICANT 0,CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch chants tri/h Business name: above service or feeder ice, 7.42 2 each branch circuit Contact name: D.Fee for brand,circuits without service or feeder fee,first / Sb.l R 2 Address: branch circuit City/State/ZIP: Each add')branch circuit / 7.42 2 -- Miscellaneous(service or feeder not included) Phone:(� ) -1 Fax: :( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder 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 See Page 2 2 Address: panel,alteration,or extension. Each additional inspection over allowable in any of the above City/State/ZIP: Additional inspection(I hr min) 66.25/hr Phone:( ) Fax:( ) investigation(I hr min) 90.00/hr Emil: Industrial plant(1 hr min) 78.18/hr _.._.- inspections for which no tee is 90.00/hr CCB Lic.: Electrical Lie.: Suprv.Lic,: spectticalklisted(�V hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal Print name: Date: 0 Plan Review Required(25%of permit fee): Slate surcharge(12%of permit fee): TOTAL PERMIT FEE: Authorized signature: —.-------- This permit application expires if a permit is not obtained within 180 f Print name: ` Date: days after It has been accepted an complete. " Number of inspections allowed per permit. 1aavOdinglPermits\ELC PerntitApp GLR_ERE.doe Rev06117/2015 440-4615T(II/05/COMrlvEn lnmrdt/�NSXs.wws�fie..eW.h:lr�]aWtinrXUNHn h^H+Xit Fn.+svH+s wo..� n'aM+dA./YNan.4naNftlhcC+eFln's.. ,*i*/.xr.e ,xnxu,'.*Xn'Ae e<aw-ifsfbsrfQn.:- Electrical Permit Application —City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORT{ONLY: FEE SCHEDULE combined: $75.00 Description i tetr. t We I Tutol Fee for all residential systemsi Renewable electrical energy systems: Check Type of Work Involved: S 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 n G• arage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 ❑ H• eating,Ventilation and Air Conditioning Solar generation systems In excess of 25 kva: System* Each additional kva over 25 7.42 3 D Vacuum Systems* >100 kva—no additional charge 0.0 3 Other: Ad , 1 4"1" Each additional inspection over allowable In any of the above: Each additional inspection is 66.25/hr charged at an hourly(1 hr min) Inspections for which no fee is 9000/hr specifically listed(h hr min) ELECTRICAL PERMIT FEES CO ILRc Al W:ORX.ONLY: Fee for each commercial system: $75.00 Subtotal(Enter on Page I): • Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: n A• udio and Stereo Systems ❑ B• oiler Controls C Clock Systems C Data Telecommunication Installation • Fire Alarm Installation C HVAC n Instrumentation L Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical n N• urse Calls n O• utdoor Landscape Lighting* n Protective Signaling ❑ other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1r\1Itutdiniffcrmits\ELC_PcrmitApp_ELR ER5.doc Rcv04/17/2015 `#fit Information Notice to Owners About ,j," __ r, Construction Responsibilities ? �,vn�rnr;;N 1I - t ••: ,` .:•• (ORS 701.325 (3)) c:r.Y 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 www.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:www.oregon,govlccb f/property_owner adopted 9-2016 This Copy for Permit 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: II own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I_ I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or fI 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. S€� V Prin Name of Permit Appli nt 5 24- t/ Si ature of Permit Applican Date Permit#: _-.___ • Address: Issued by: Date: =1=I? This Copy for Permit Offices