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Permit CITY OF TIGARD ELECTRICAL PERMIT `A ! COMMUNITY DEVELOPMENT Permit#: ELC2021-00464 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/24/2021 Parcel: 2S104BA10600 1 Jurisdiction: Tigard Site address: 13665 SW LIDEN DR Project: Luu Subdivision: CASTLE HILL NO.3 Lot: 136 Project Description: adding(2)lights and 2 electrical GFC to addition. 11/1/2021:REPRINTED permit to include(2)additional branch circuits for bathroom and shower tile. Contractor: CONNECTIONS ELECTRIC INC Owner: LUU &CHAU REVOCABLE TRUST PO BOX 7136 BY LUU, MARK& SALEM, OR 97303-0026 CHAU, TU TRS 13665 SW LIDEN DR PORTLAND, OR 97223 PHONE: 503-390-7914 PHONE: FAX: 503-463-6863 FEES Quantity Description Date Amount 1 ea 12%State Surcharge- 08/20/2021 $7.63 Specifics: Electrical 2 crt Branch Circuits wo/Purchase 08/20/2021 $63.60 Type of Use: SF Service or Feeder Class of Work: ALT 2 crt Branch Circuits w/Purchase 11/01/2021 $14.84 Type of Const: Service or Feeder Occupancy Grp: 0 ea 12%State Surcharge- 11/01/2021 $1.78 Electrical 45 Misc Administration Fee 12/01/2021 $45.00 Total $132.85 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 copy of the rules or direct questions to OUNC by callina 50321987 or 1.800.332.2344. Issued By: lL%��J7 Permittee Signature: 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 Applicationimmimmiimaimm City of Tigard 1f1, \�// 11'�f iRieceived � g VEI Y ED J( PemtttL 6 ,,.riylcoil K 13125 SW Hall H1vd.,Tigard OR y Flan Rovt� ( ��< �� � ���t/`' Phone: 503.718.2439 Fax: 503.59,.1 Date,'11y: Related Permit rr; Inspection Line: 503.639.4175 Ready 0atef13y !aria: air See Page 2 for 1 lt, ,l � Internet: wwww tigard-ot gov DEC 1 UZ1 Notified/Method: �� Supplemental Information r,:^94M. ait5} irik t i�1; ,Cord:•' .'. .!. :+ (n ' .: ? T . °f .:.* .«A LVIEV,s-g p"M 9 , E]New,construction laAdditionlalterati?/ r eeen- Please check all that apply(submit l set,of plans wlitems checked). p Demolition ❑Other: BUILDING DIVISION 0 Sevtee or feeder 400 amps or more ©Building over three storiea. itz where the available fault current Q Marinas and boatyards. • tt '., s t � tw i4:, t ^,r - �'" „'r r exceeds 10,000 amps at 150 volts or 0 Floating buildings_ } ® I-and 2-family dwelling 0 Conlntercial,industrial 0 Accessory buildrn less ground,ore eels 14,000 ❑Con iercial use agricultural ❑Multi-family Master builder Other: amps for all Other installations. buildings. rite pump. O installation of 150 KVA or �x r r, fyt y'x ,... „ t h *: i 4 ' ❑.fimergencysystem. ...� ,.: y ���, � - •si O larger separately derived Job Job site address:13665 SW Lide 't` �I� O Addition of nevi motor load of system. /� __� 1001#P or more. City/State/ZiP:Tigard, OR 97223 VW ❑Six ur more residential units, occupancy. -- O Health-care facilities, O Recreational vehicle parks. Suite/bldgiapt.#: _ Project name: 6.4ti 0 Hazardous klcgtiuns. ❑Supply Vrlta;te for more than 0 Service or feeder 600 am s or more• 600 Volts nominal. Cross street/directions to job site: ,a , <._& Desetlption t Qty. e>,eh Total II New residential single-or multi-family dwelling unit. Subdivision: Lot#: ; includes attached garage. fax map/parcel#: I,000 sy.R.or less 1—16g,54 4 ( Fa,add'1500, ft.or portion - I t +rr r • -= P 33.92 1 ° � s � ', &a,'< Limited energy.residential _ Please add contractor to permit ELC2021 00464 (with above sq.ft.) 75110 2 -- Limited energy,mufti-family • 1 residential(with above sq.IL) 75.00 2 t f i" } � 1 Renewable Energy 0 See Page 2. o i „+err 1U.2 4' "r" " 's; ,-.' ` .k�'. .4.'` ",o Services or feeders instiffiation,alteration,andior relocation Natne:Mark Luu 200 amps or less 100.70 Address:13665 SW Liden Dr. �� 201 amps to 400 amps _ 133 56 2 1 401 amps to 600 City/State/ZIP:Tigard, OR 97223 amps 200.34 2 60i amps to 1,000 amps 101.0; 2 _ Phone:( 503)849-5156 Fax:( ) over 1,000 amps or volts 552.26 Email:markiuu ai7gmail.COR1 Temporary services or feeders installation,alteration,and/or relocation Owner installation:This installation is being made on property that 1 own which is not 200 amps or less 59.16 ' 1 Intended for sale,lease,rent,or exchange,according to ORS 447,449.670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 11/24/2021 401 amps to 599 amps 168.54 2 ii` i ,;r"e's •' as - :j �_ Branch circuits-nevi:alterations or extension,per panel • A.Fee far branch rirnuitx with Business name: above service or feeder fee. each branch circuit 7.42 Contact name: B.Fee for branch circuits without Address: service or feeder fee,first branch circuit 6.1 is City%State/ZlP: —1 Each add')branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax::( ) Each manufactured or'nodular dwellingservice attdlor feeder _ I 67.84 2 Email: ' _t ' '1.,. �,i Reconnect only 67.84 i 2 , ','i Pump or irrigation circle 67.84 L... ' Business name: 0ny'ye(f,rvt, ( i.r 4,416 i C Sign as outline lighting 67 84 2 Address: 4 ie1;, d s a` Signal circuit(%)or limited-energy w , _T ,,y 4� � 0 s/od. (3 t� aanel,altcmtioa,or extrnsitm. 1 0 See Page 2 2 {;itylStatelZiP: g... _(,�_� � 17 3 Q 3 Each additional inspection over allowable In any of the above AddtUonai inspection(1 hr min) 66 2S'hr Phone:(50 ) pa J - 4/ 0 Fax' Kt!o3- /�(_ 1 ('�a 3) Grn�fQ 3 htvesngatum(t hr min) WOO'hr Email: �� n>' industrial plant(1 hr mint 78.18`hr 6-t�ILf C )'1 C iDrsS it tUG C. Gym...,i" ,(o . _ i f'C B Lie.: Inspections for which no fee is i - iv s Electrical Lie,: .61•-2`�$L Suprv.Lic.:3411 S- a cities!!•listed 'ixhrslits 90.00 In Subtotal: Suprv.Electrician signature,require Print nameN.ds(yvi,Cv;^ -%leg e„v Date: fj1/1p.fri 4 0 Plan Review Required(25%of permit fee): Stale surcharge(129ie of permit fee): Authorized signature: TOTAL PERMIT FEE _tv Ms permit application expires if a pewnt(t is nut a within 18 Print name: Date: days after It ban been accepted an romp " Number of inspections allowed per permit. 1+rloitdirg'Per mitoFLC.._Pet mit App_HLR_ERE.;ka:Rev 00/11'2015 4451-4t15T(11:0S'COMMEA ,F : 1 111 CITY OF TIGARD �\ + Z` ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2021-00464 Date Issued: 8/24/2021 T I GA RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104BA10600 Jurisdiction: Tigard Site address: 13665 SW LIDEN DR Project: Luu Subdivision: CASTLE HILL NO.3 Lot: 136 Project Description: adding(2)lights and 2 electrical GFC to addition. 11/1/2021 REPRINTED permit to include(2)additional branch circuits for bathroom and shower tile. Contractor: OWNER Owner: LUU&CHAU REVOCABLE TRUST BY LUU, MARK& CHAU, TU TRS 13665 SW LIDEN DR PORTLAND, OR 97223 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 1 ea 12%State Surcharge- 08/20/2021 $7.63 Specifics: Electrical i 2 crt Branch Circuits wo/Purchase 08/20/2021 $63.60 Type of Use: SF Service or Feeder Class of Work: ALT 2 crt Branch Circuits w/Purchase 11/01/2021 $14.84 Type of Const: Service or Feeder Occupancy Grp: 0 ea 12%State Surcharge- 11/01/2021 $1.78 Electrical Total $87.85 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 at 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 cony of the rules or direct questions to OUNC by callina 503.232.1987 or 1.800.332.2344. Issued By: Ho-Um V De,We4f- Permittee Signature: 0K'Apv-Liza4-i,uvt 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 n Electrical Permit Application OCT 2 7 2021 l Olz OFFI( I. t si.0.1.1 City of Tigard Received r 13125 SW Hall Blvd.,Tigard, 972 ITY OF T IGARD Date/8 : i/ / 'yr1.� ��� ,t 3 OR DING DIVISION Plan Review Phone: 503.718.2439 Fax: 503.59 Date/B Related Permit#: Inspection Line: 503.639.4175 Ready Date/By: inns: Et See Page 2 for T I G,1 R!) Internet: www.tigard-or.gov Notified/Method: f of I J r/i `(�Gi( Supplemental Information �4DDTD tc2o2l 0046y 'FY,PI. OF oo ` dii,eitsvottil";"P10 PLAID R1litllw New construction 91 Addition/alterah t 1 u l! t 11' Please check all that apply(submit 2 sets of plans w/items checked): Demolition ❑Other: t 1 �1 ❑Service or feeder 400 amps or more ❑Building over three stories. II where the available fault current 0 Marinas and boatyards. CATEGORY OF CON:. 'V, -„ , 'r ' exceeds 10,000 amps at 150 volts or ❑Floating buildings. and 2-family dwelling 0 Commercial/industrial El Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural Multi-familyMaster builderFire for all other installations. Instaings. 0 ❑ 0 Other: ID pump. 0 Installation of 150 KVA or JOB SUPECINFORNIATION AND LOCATION ❑Emergency system. larger separately derived ❑Addition of new motor toad of system. Job#: i Job site address: 136c5s s vJ LstAl b r 100HP or more. ❑"A'.°`E","1-2",``1-3", City/State/ZIP: I ward o p q l rl s ❑Health-care It mare facies. units. occupancy. U F "1 lo(.oe,� ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: I Project name: Mark LV J ❑Hazardous locations. CI Supply voltage for more than 0 Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description 1 Qty. 1 Each I Total 1 New residential single-or multi-family dwelling unit. Subdivision: I Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'I 500 sq.ft.or portion 33.92 1 I)E'SCIIIPTIfJ f`OrWORK ' Limited energy,residential /t 414 2- .2.k ck- 4 �� :Na'+' Q4( l4.d-i / (wedth energy sq., ti 75.00 2 �`t q0� t�j Limited energy,multi-family A�Q- l residential(with above sq.ft.) 75.00 2 6 0"4'`t� I " : `' .- RenewableEnergy ❑ See Page 2 talitTpv TY 0'TE A fiT Services or feeders installation,alteration,and/or relocation Name: w MA+�1� 200 amps or less 100.70 2 • Address: i z!!�6s S W LA curl D 201 amps to 400 amps 133.56 2 �J�o 401 amps to 600 amps 200.34 2 City/State/ZIP: dl Op- (4144. 3 601 amps to 1,000 amps 301.04 2 Phone:(5�) 84a1... i S6 Fax:( )In Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: rill g Y 1c 1,1.It p y� alt. _ tom, relocation Owner installation:This installation ieing made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,re t,or exchange,actor rig t S 447,449,670,and c,701. 201 amps to 400 amps 125.08 2 Owner signature: ��L7�-- Date: 1(Z 1 f o�Z0� 401 amps to 599 amps 168.54 2 !!! Branch circuits—new,alteration,or extension,per panel ' '• ElPERS°N A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit Contact name: M of r VC L.V t B.Fee for branch circuits without 3 S c vj � D service or feeder fee,first 56.18 2 Address: J branch circuit City/State/ZIP: 1i• �'d 0 ql ,� Each add'I branch circuit a 7.42 /41,1 2 Miscellaneous(service or feeder not included) Phone:(S(33) ('it l „ 51 5)c, Fax::( ) Each manufactured or modular D y'T.' dwelling,service and/or feeder 67.84 2 Email: mgrIL W‘A (y) rtuX1i s, (.p Reconnect only 67.84 2 PI RACTOR Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy 0 see Page 2 2 Address: panel,alteration,or extension. g 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 hr min) 78.18/hr Inspections for which no fee is specifically listed '/z hr min 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lic.: P y ( ) .ELE s teat P 11 ICES : Suprv.Electrician signature,required: Subtotal: /1-I- $"i"( Print name: Date: 0 Plan Review Required(25%of permit fee): --- State surcharge(12%of permit fee): J.: TOTAL PERMIT FEE: Authorized signature: ��C (!� 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. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-46157(1 I/05/COM/WEB Y V.d eaAdteiae,Ni+w:azz Ja.ex+r.. xa.a+xf.-h 4lxxuuNtGuakritw3ri#iYt4EPai..AimrB#eaJ3i«<+ r .....«.., c .,,..e.. .. .•ru+.A .oiu wwaxx v»+umat muk3ltend.nswtuid+Ntx.smaraat 'zrs.uew.rs+:rw.rrtwar.aiva..3aiws.. RECEIVED OCT 2 7 2 1 Property Owner Statement die OF TIKL) Regarding Construction Responsibilities BUILDING D)CISI 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: 1 ___ I own, reside in, or will reside in the completed structure and my general contractor is: I 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. Print Name� of Permit Applicant ----LI —e' /o/ 7/0 /_ Signature of Permit Applicant Date Permit#: _ �, — Address: (�; " ^�'` \F Issued by: Date: it:. This Copy for Permit Offices •F Information Notice to Owners About "7 " = Construction Responsibilities 14 (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 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. a 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.aovlccb This Copy for Permit f/proo. cry owner adopter!9-2016 J CITY OF TIGARD ELECTRICAL PERMIT '' . '. COMMUNITY DEVELOPMENT Permit#: ELC2021-00464 Date Issued: 8/24/2021 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104BA10600 Jurisdiction: Tigard Site address: 13665 SW LIDEN DR Project: Luu Subdivision: CASTLE HILL NO.3 Lot: 136 Project Description: adding(2)lights and 2 electrical GFC to addition Contractor: OWNER Owner: LUU&CHAU REVOCABLE TRUST BY LUU, MARK& CHAU, TU TRS 13665 SW LIDEN DR PORTLAND, OR 97223 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 1 ea 12%State Surcharge- 08/20/2021 $7.63 Specifics: Electrical 2 crt Branch Circuits wo/Purchase 08/20/2021 $63.60 Type of Use: SF Service or Feeder 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 throuah OAR 952-001-0090. You may obtain a cony of the rules or direct auestions to OUNC by callina 503.232.1987 or 1.800.332.2344. Issued B t(oU'VGLVL�PAV 0vvAppU;cat't,a-vt y: e'e Permittee Signature: 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. DElectrical Permit Applicat llEIVE r(I►. ► I( I I SI (),,., City of Tigard I{�Q 1 6 2021 Received���q��� -;1 Permit4.tiro, g 3H l7 Gt7L7 Date/B : L(/!-f III • 13125 SW Hall Blvd.,Tigard,OR 9722 Plan Review �n ' • Phone: 503.718.2439 Fax: 503.59 1�y OF TIGARU e/e Dat : Related Permit#�(S7101r'(: , , Inspection Line: 503.639.4175 Ready Date/By: orris: ® See Page 2 for TIGAKI) Internet: www.tigard-or.gov IUILDING DIVISION Notified/Method: Supplemental Information 1 0 � rtxkrr1 , . S rarry' ivi vA ib , r REVIEW v ❑New constructionAddition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards. i /rE ORY OF CON ON ,4S exceeds 10,000 amps at 150 volts or 0 Floating buildings. and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or .jo '.iATE INFOIMAX1444NO;LOCH' Ai ❑Emergency system. larger separately derived ❑Addition of new motor load of system. Job# Job site address: 1366, 5.3 L I A IA 15*Ca 10OHP or more. ❑"A"."E","1-2","1-3", /ZIP:Cit /State T ❑Six or more residential units. occupancy. City/State/ZIP: e6u I 0 f� c/7 22,3 o Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name: M K 1 L. ❑Hazardous locations. 0 Supply voltage for more than 0 Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEi?IEJ Description I Q . I Each I Total I New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax map/parcel# Limitedgy,e 1,000 sq. less 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 1 ,, i ,p `1 �, t it 8 I,,:`�$/v' ener ,residential �` ) -} "' (with above sq.ft.) 75.00 2 1( HL -(�?Lk{;� TU !0 t�lH� owt tC /0 .� Limited energy,multi-family 75.00 2 - I t i .� s �/ r.; residential(with above sq.ft.) VA L� I,` 7, Renewable Energy 0 See Page 2 ,. -Mr__. „-•-• ' ,Oviesat .•. �.•t -, r°t•"" -'' Services or feeders installation,alteration,and/or relocation Name: /Lt,r I_.. , , 200 amps or less 100.70 2 Address: I ?)CC$ ' j�(� (_ 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: tG r� c)i ' 72.7 3 601 amps to 1,000 amps 301.04 2 Phone:(S O`i —S 1 . Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: tt- � t LA,L.t4P 0,74ek 1( , SST,,,,` relocation Owner installation:This installatim4s being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,re or exchange cc din o ORS 447,449,670,and 7 1. 201 amps to 400 amps 125.08 2 Owner signature:,----1.- %t^ ',...--1...-- -- Date: , / 1 401 amps to 599 amps 168.54 2 Branch circuits-new,alteration,or extension,per panel • 0 CO?1'I'ACT PERSaN A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit Contact name: / . i&C K. L_t,,. LA B.Fee for branch circuits without service or feeder fee,first I Address: , cc s /J i j 4,r �, ,„ t,f branch circuit 56.18 2 City/State/ZIP: —T ,, ,c-c4 0 1. 17 Z Z -3 Each add'l branch circuit j 7.42 2 Miscellaneous(service or feeder not included) Phone:( � S L(. Z'C G Fax::( , ) Each manufactured or modular "As F-(�1�� 144 l 1 • w d Reconnect only e and/or feeder 67.84 2 Email: I 67 84 2 t co Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67.84 2 Signal Address: panel,alteration,oor extension. 0 See Page 2 2 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(1 hr min) 78.I8/hr Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(%z hr min) Suprv.Electrician signature,required: AL) ` g 4 Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): .��,t State surcharge(12%of permit fee): Authorized signature: ,ram !L,'L,`?� G TOTAL PERMIT FEE: 7(.23 This permit application expires if a permit is not obtained within 180 Print name: f, v(' ✓. . L LA (2 Date: X/f / 'i_,J days after it has been accepted as complete. l I * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB