Permit CITY OF TIGARD ELECTRICAL PERMIT
= COMMUNITY DEVELOPMENT Permit#: ELC2021-00566
Date Issued: 10/7/2021
T i G A R L? 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S1106A05200
Jurisdiction: Tigard
Site address: 11755 SW WILDWOOD ST
Project: JAEGER Subdivision: SHADOW HILLS Lot: 13
Project Description: Adding(20 branch circuits.
Contractor: OWNER Owner: JAEGER,JULIE&STEVEN
STEVEN JAEGER 11755 SW WILDWOOD ST
11755 SW WILDWOOD TIGARD,OR 97224
TIGARD, OR 972224
PHONE:
PHONE: 480-229-5151
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 10/06/2021 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/06/2021 $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 throuah OAR 952-001-0090. You may obtain a coov of the rules or direct ouestions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Ho-WI-WIVaA,De thlege, Permittee Signature: 0l't'App-Liza4-i-avv
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.
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RECEIVED
Electrical Permit Application FOR OFFICE USE ONLY
OCT 12021 Received
►I
R ve
City of Tigard Date/By: LQ 6' ,),/ A , ZL' /--(iO3—C,A"
:III n 13125 SW Hall Blvd.,Tigard,OR 97t?,jTY OF TIGAIBL) Plan Review
Phone: 503.718.2439 Fax: 503.598.. 6 Date/By: Related Permit II:
Inspection line: 503.639.4175 BUILDING DIVISION Ready Date/By Fa See Page 2for
l i G A R 13x www
.tigard-or.gov ww .tigard-or.gov Notitied/M•thud:i /11 a Supplemental Information
—
TYPE OF WORK ,/ PLAN REVIEW
0 New construction Addition/alteration/replacement Please check al_ t 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 ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 snips at ISO volts or 0 Floating buildings.
1-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.
0 Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation oft 50 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
• ❑Addition of new motor load of system.
Job#: Job site address: I t r;� ,)1 Ai .l 1 I L i--. l0011P or more. ❑"A","r,"1-2, l-3",
0 Six or more residential units. occupancy.
Panc
y.
City/State/ZIP: ' / Z ZtI ❑Health care facilities. 0 Recreational.vehicle parks.
0 a le_r
Suite/bldg./apt.t.#: Project name: ❑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 SCHEDULE
•
Description —
ch To Fatal
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: includes attached garage.
1,000 sq.tt.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(with above sq.ft.)
_ Limited energy,multi-tamily 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
'PROPERTY OWNER ❑ TENANT _ _ _ Services or feeders installation,alteration,and/or relocation
Name: > rr 200 amps or less 100.70 2
� `j a 201 amps to 400 amps 133.56 2
Address: I l g_ s V i I ` !-` -- 401 amps to 600 amps 200.34 2
City/State/ZIP: f- .� -7 601 amps to 1,000 amps 301-04 __2
Phone:(Li 5t) 2Z1 Of 5)S1 Fax:( ) Over 1,000 amps or volts 552.26 2
^ Temporary services or feeders installation,alteration,and/or
Email: 5 e-W t\ 0- ,s*e,�e.t,1 ' .0f Il • ^(%0 PA relocation — —
Owner installation:This installation is being 4•e on .1-perty that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent r exchp,rig�,according to ORS 447,449,670,and 701, 201 amps to 400 amps 125.08 2
r
Owner signature: I 6 Date: 2g/2-I 401 amps to 599 amps 168.54 2
❑ APPLICANT ! ` 0 CONTACT PER ON Branch circuits-new,alteration,or extension,perpanei
A.Fee for branch circuits with
Business name: above service or feeder fee, 7.42
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
City/State/Z. - Each add'l branch circuit 7.42 2
-- —
__ _ --- -- • - Miscellaneous(service or feeder not included)
Phone:( ) 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: A( Sign or outline lighting 67.84 2
r`� Signal circuit(s)or limited-energy 2
Address: panel, ❑ See Page 2 alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/Z.IP: Additional inspection(1 hr min) 66.25i hr
Phone:( ) rFax:( ) Investigation(1 hr min) 90.00'hr
Industrial plant(1 hr min) 78.18!hr
Email: Inspections for which no fee is
90.00/hr
CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed(1/2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 02,.Cecj
-
Print name: Date: 0 Plan Review Required(25%of permit fee): r
State surcharge(12%of permit fee): '-7. 07,
77 Authorized signature: TOTAL PERMIT FEE,: I 2�
This permit application expires if a permit is not obtained within 180
Print name: ..'\-Zv e-j l exe__( r I Date:01/ !/O/ 2 1 days after it has been accepted as complete.
:w ., ,
Property Owner Statement
RECEIVED
Regarding Construction Responsibilities OCT 12021
Oregon Law requires residential construction permit applicants who are not licensed within OF TIGARL)
Construction Contractors Board to sign the following statement before a building permit& ING DIVISION
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
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 I reside , residence I will
reside in. If I hire subcontractors, I will hire onlyresidence subcontractorsthat licensedin or witha 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--c--bi€ ( „ec r
Print Name of Permit Applicant ✓
,...._______4„<:4
(CY( / 2- t
Signature of Permit Ap9lt Date
Permit#: O F oN
Address: ; es\
r'
Issued by: Date: 9/