Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
■ COMMUNITY DEVELOPMENT Permit#: ELC2021-00487
Date Issued: 9/2/2021
T I G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S134CD03600
Jurisdiction: Tigard
Site address: 11950 SW KATHERINE ST
Project: Baccellieri Subdivision: LERON HEIGHTS NO.3 Lot: 63
Project Description: Install 201-400 amp service and(18)branch circuits for installation or moving of outlets and switches for lighting.
Contractor: OWNER Owner: BACCELLIERI, FRANCES D TRUST
11950 SW KATHERINE ST
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Services or Feeders-201 to 400 amps 09/01/2021 $133.56
Branch Circuits w/Purchase Service or 09/01/2021 $133.56
Feeder
Type of Use: SF 12%State Surcharge-Electrical 09/01/2021 $32.05
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 $299.17
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. Y u may obtain a opy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 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 Application RECEIVE V FOR OFFICE i'SI i,.I ,
City of Tigard "`�C E I Y E I .jived c /� /t f� D
t Date!By: 1/f/Z1 .d d Pertnil°EL-l. ZO N—DO `b O 7
nl 13125 SW Hall Blvd.,Tigard,OR 97223 AUG 2 6 2021 Plan Review
Phone: 303.718.2439 Fax 503.598.7960 Date/By: Related Permit a:
I I t li 1, Inspection Line: 503.639.4175 - OF TIGARCJ Ready Dele/By: p 7uris• la See Page 2 for
Internet: www.tigard-or.gov Notified!Method:III Z" �' . Supplemental Information
TYPE of WORII3UILDING DIVISIO 1:57%74.,L_ F pit_i PLAN REVIEW
❑New construction ['Addition/alteration/replacement Please check all that apply(submit E sets or plan,w:item,checkedi:
❑Demolition 0 Other: ❑Service or feeder 400 amps or more 0 Building over three stories
where the available fault current ❑Marinas and boatyards.
CATEoORY OF CONSTRUCTION exceeds 10,000 amps as 150 volts or 0 Floating buildings.
[ I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-tse agricultural
aetsi for all other installations, buildings,
❑Multi-family 0 Master builder 0 Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCA7100 = 0 Emergency system larger separately derived
Job#: Job site address: l p .0 11 t},1 t e� L ❑Addition of new mover bad of system.
1 l 1 S0 d� 1' e �Y�1,11�tte.�f� 100HP or more. ❑..A".`E....1.2..,„I-7_,
City/State/ZIP: T E 6 ft i t Ce 9-7.a ❑Six or more residential units. occupancy.
�r] 3 ❑Health-care facilities_ ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: y/ GGe l 't^�, 0 Hazardous locations. ❑Supply voltage for more than
�J-� 0 Service or feeder 6(10 amps or more. 600 volts nominal.
Cross street/directions to job site: I ^ SP. :
tat � FEE SCHEDULE �,a,. ` �`
Dmerlpdw I Qty. I Esea Hiram
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or ponion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
.,/ 1� (with above sq.fl.) 75.W 2 .
I Yt`St ,t"' (t �'O-? J� 07 Lc. l jf' Limited energy,multi-family
D- Sf a 75.00 2 lib
O(n residential(with above sq.ft.)
Rw, i-c E��s3 �'a.r L; �"ft NI-
age 2
tee' ERTY OWNER ❑ TENANT SenewableEedersrgy ❑ So and/
Name: ('� Services or feeders Installation,alteration,and/or relocation
rY.E...ta K.. giLaw CG'ey, 15/£,.re-Q( 1 ,-erx 200 amps or less 100.70 2 tit
Address: 111,5- 201 amps to 400 amps / 133.56 )4 s3 54 2
—� k ±...e. G iA 401 am to 60o a
City/State/ZIP: --�- A Ps amps 200.34 2 _
! t 0"r 4 la-4-3 ' 601 amps to 1,000 amps 301.04 2
Phone:(St L�/ � TFax:( ) Over 1,000 amps or volts 552.26 2
Email: '((IOO J Temporary services or feeders Installation,alteration,and/or
ra_ode__i dam tet e_� 1,440-i I . Ct vI i relocation
Owner ins allation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
intended for e,lease,r t,or ex ccor ' S 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner sign - -Date: Y/n ' ,I s24 401 amps to 599 amps 168.54 2
( PLICANT / }2 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with Q
Business name: above service or feeder fee, //0 7.42 /33,6d 2
t each branch circuit
Contact name:
. e• 41.-"s .......6 D Je B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
--- Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
Email:
dwelling,service and/or feeder 67.84 2
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
Address: ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25!hr
Phone:( ) Fax:( ) Investigation(I hr min) 90.00/hr
Email: Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00.hr
CCB Lie.: Electrical Lic.: Suprv.Lie.: specifically listed(SS hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: (s 7,i.2_,
Print name: Date: 0 Plan Review Required(25%of permit fee): as-
Authorized
State surcharge(12%of permit fee): 3 z,
signs \ ly- `. �1- •' TOTAL PERMIT FEE: .fig G�' /7
__ This permit application expires If a permit is not obtained within 1a0
Print name: s-was //_1.+.• :t P-'1/. 7 Date: g J a-L )al e! days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:46ild61g:Permns1.E1,C PermirApp El R_IFRG doe Res(1E17'22015 44046157(11105/COMWEa
RECEIVED
Property Owner Statement AUG 2 s 2021
Regarding Construction Responsibilities CITY OFTIGARD
Oregon Law requires residential construction permit applicants who are not licensed*WING DMSION
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
L_ I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
Of
rI 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 COB 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.
film. Dicer /1/ r l
Print Name of Permit Applicant
1 .• _ (/31)/.)._,
Signature of Perm li Date
Permit#: Et-L' Z'21 —00 `'f 8 7
Address:
119-CO S CA) 1 �--n.-fair- S7 � y . .
Issued by: fr
Date: I roz/, t i
This Copy for Permit Offices