Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
Permit#: ELC2021-00486
__ •
COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/2/2021
Parcel: 1S134DC05600
Jurisdiction: Tigard
Site address: 11800 SW 113TH PL
Project: Thomason Subdivision: MUTTLEY'S ADDITION Lot: 19
Project Description: (2)branch circuits for outlets and outdoor lighting for new enclosed sunroom.
Contractor: OWNER Owner: THOMASON, RONNIE G&LAURA L
11800 SW 113TH PL
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Branch Circuits wo/Purchase Service or 09/02/2021 $63.60
Feeder
12%State Surcharge-Electrical 09/02/2021 $7.63
Type of Use: SF
Class of Work: ALT
Total Number of Systems:
Audio&Stereo: N
Security Alarm: N
Garage Door Opener: N
HVAC: N
Vacuum System: N
Other: N
Other Desc: 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 through OAR 95 1-0090. You y obtain a`cop s or d' ct questions to OUNC by calling 503.2 .1987 or 1.800.332.2344.
Issued By: Permittee Signature: ( !//. L!/r4
OWNER INST ATION 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 RECEN FOR OFFICE usl. <)\l l
- City of Tigard AUG ,7 2021 Received Permit# ,/_ f.,CP(,111 • 13125 SW Hall Blvd.,Tigard,OR 97223 Date B ' tCL C�
Phone: 503.718.2439 CITY OF TIGARD Plan Revieww �� �d
DateB Related Permit#:
TIGARD Email: TigardBuildingPettnits@Tigard-o a LDIN�7.DI�ISIO"I Ready Date/By: a/� 7uris: WI See Page 2 for
Inspection Line: 503.639.4175 Internet: www.tigard-or.gov NotiB,edd/M�ethod: 2-1 Supplemental Information
TYPE OF WORK c'-/I'4 Lf%-tA4- 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.
❑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.
12t,_and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: �/t�{� p Th yn 1 ❑Addition of new motor load of system.
1 `�-a VV S1,0 It3 1 1 ' 100HP or more. ❑••A,,,"E,,••l-2"••13"
City/State/ZIP: 1 I �(��i 0 c Z 2 3 El Six or more residential units. occupancy.
v//1, 1 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 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: "r,ga-AI St FEE SCHEDULE
Description I Qty. I Earls I Total I *
� New residential single-or multi-family dwelling unit.
Subdivision: I�a -1-4L AI t A 5' ,f J 4-( n-� Lot#: (4 Includes attached garage.
Tax map/parcel#: I S t 1 Ai
( p.5- if l 1,000 sq.ft,or less 168.54 4
� Ea.add'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
jn� / ,, 0 (with above sq.ft.)' 75.00 2
/S 3 e L tJ O U ttetS a.An.o. 2 ` 3 D 0±d v is(` Limited energy,mult-family
residential(with above sq.ft.) 75.00 2
� �— l tti 'a �u� Cu A Qaann(I►1 S 1 ZcZo-0�135/ Renewable Energy 0 See Pa e2
PROPER El TENANT g
((�� tj Services or feeders installation alteration,and/or relocation
Name: Rs,A A.v e_ am.ol. (,.A. v rQ�" U►'k(,�5 D t/1, 200 amps or less 100.70 2
Address: \1 i D° S k) ( (7 i i , Qt( -- 201 amps to 400 amps 133.56 2
J R .
1 401 amps to 600 amps 200.34 2
City/State/ZIP: Tt 4 art,t t 0 R.. 9'7 2'23 601 amps to 1,000 amps 301.04 2
Phone:(s03) L( 3 t - Z.a tt I / Over 1,000 amps or volts 552.26 2
LT G1.o An. /� LD G a-S 1. . �n� Temporary services or feeders installation,alteration,and/or
Email: I `r t' "( C� relocation
Al nstallation.This installation is being made on property that I own which is not 200 amps or less 59.36 1
m en for sale,1"�/}"sic rent,or ex ge,according to ORS 447,449,670, d 701 201 amps to 400 amps 125.08 2
Owner signature: `. �t,v' ,��'l�n, Date: Z 3 2,1 401 amps to 599 amps 168.54 2
APPLICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: li Cr- ..,12_ above service or feeder fee, 7.42 2
.� each branch circuit
Contact name: , t- & l La vuk_a,S O A B.Fee for branch circuits without
service or feeder fee,first 56.18 ' 2
Address: I l S Q a 5 t i branch circuit
City/State/ZIP: -7- , `Jr a-r a. r) D- Each add'l branch circuit 7.42 ` 2
/+ Miscellaneous(service or feeder not included)
Phone:(5 05) - '' _ Q t' S 'n tom1 ( (, e_ l\ It)J Each manufactured or modular
/n�\` dwelling,service and/or feeder 67.84 2
Email: L I Li V� @ C D,"COl5i • 1tie-.—t
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Bus' ess name: Q e,,ver Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address:
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
Email: `` -" Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.: El Cal LiC.: Suprv.Lie.: specifically listed('h hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician si ,required: Subtotal: (p 3,G 0
Print n Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 1. (0 3
Authorized signature:
Date: g TOTAL PERMIT FEE: 7 t, 2 7
Print name: d Jl�r L
''a� c �. /Z. 3 Z l This permit application expires if a permit is not obtained within ISO
i 3 l) Y� days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:03uildisg\Permes\ELC_PermitApp ELR_EREdoe Rev 10/26/2017 440-46I5T(I1/05/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 I Qty. I Each I Total I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
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:
r] Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >l00 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 an of the above:
❑ Other Each additional inspection is 66.25/hr ]
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
11Building\Permits\ELC_PetmitApp_ELR_ERE.doc Rev 10/26/2017
RECEIVED
Property Owner Statement SEP 01 2021
Regarding Construction Responsibilities BCITYOFTIGARD
LDING DIVISION
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:
NIA
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
XI 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.
I ( ' oo Sw IL3 '-1-' P( -
Print Name of Permit Applicant
I!Cw re, 77/0-14A4'xS1A- 1 ( S a ( Z (
Signature of Permit Applicant Date
Permit#: C-G C 02-d c-/ - 0 e W--6:)
QF
Address: //cf ) fG� //,3 /�e__- ,c r6 + li-
/ : •
Issued by: At- Date: /11., �2f
This Copy for Permit Offices