Permit 1111 CITY OF TIGARD ELECTRICAL PERMIT
•
COMMUNITY DEVELOPMENT Permit#: ELC2021-00495
T i i;A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/21/2021
Parcel: 1 S 125 DB04400
Jurisdiction: Tigard
Site address: 7160 SW TAYLORS FERRY RD
Project: Gilchrist Subdivision: SHADY DELL NO.2 Lot: 18
Project Description: (1)branch circuit for recessed lighting in living room.
Contractor: OWNER Owner: GILCHRIST, JOHN PAUL&MICHAYLA
7160 SW TAYLORS FERRY RD
TIGARD,OR 97223
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 al Branch Circuits wo/Purchase 09/20/2021 S56.18
Specifics:
Service or Feeder
1 ea 12%State Surcharge- 09/20/2021 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 cony of the rules or direct questions to OUNC by calling 503.232.1987 or 1,800,332.2344.
Issued By: Hally Vail/De,Wage Permittee Signature: OrliAp .CatIx vt
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.
DECEIVED -g12r2'
Electrical Permit Applica IOil (II III I I 'sr I,�l '
City of Tigard4EP 2 Received �g ' /r ,RA
• 13125 SW Hall Blvd.,Tigard,OR 9722.i �` `� Date/B : �? 4 '`
:�' Plan Review Related Permit#:
Phone: 503.718.2439 Fax: 503.SA8.1460 aF TIGARD °"°'f'
Inspection Line:ins: 503.639.4175 Ready Date/By: E3 See Page 2 for
I II�.�I:It Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method:•
—� Supplemental Information
111
TYPE OF WORK • PLAN REVIEW
0 New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of piano w/items checked):
•
•
El Demolition ❑Other: ElService or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
• CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings,
❑ 1-and 2-family dwelling ID Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Com soreiat-use agricultural
amps for all other installations. buildings,
❑Multi-family ['Master builder ❑Other: 0 Fire pump
.p. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency syscem larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: -7140 SW -7�,(as retry Rd 100HP or more. ❑"A","E","I-2 "I-3",
/ I'Cn ❑Six or more residential units. occupancy.
City/StatC/Z1P: Tioa1PG[ /Y / R72a3 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: • d.t• I : 0 Hazardous locations. ❑Supply voltage for more than
.1 shiny �9 ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Conniption I Qty. I Each I Total I •
New residential mingle-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less tbssa 4
Ea,add'I 500 sq.fl.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
TT �//� J (with above sq.ft.)
75.00 2
J.ilS Mill t‘rcGrsed 4111 o'Sj PI. fi1/�G Limited energy,multi-family 75.00 2
tvJ .J .J residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
PROPERTY�fJWNER TENANT
I r Services or feeders installation,alteration,and/or relocation
Name: jD/f�t �4 f7ol r(It re.•S 200 amps or less 100.70 2
20i amps to 400 amps 133.56 2
Address: —7/6 Q SW 7 a-s 'Fr�ry Rd
City/State/ZIP: �7 p 401 amps to 600 amps 200.34 2
Rc Q/t / (7s 3 601 amps to 1,000 amps 301.04 2
Phone:jag ) Id_ 9K35 Fax:( ) Over 1,000 amps or volts 552.26 2
� J� _ Temporary services or feeders installation,alteration,and/or
Email:Jwc1�+'J�/�fY,•s Q� fNM�.[dMa relocation
Owner installafon:This installation eing made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or an cording to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: I$.-r 1,....,-off/ 4111 amps to 599 amps 166.54 2
ptAPPLICANT I 0 CONTACT PERSON Branchcircuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: J /` / above service or feeder fee,
(lily, l/(,dl,t•1 [�,,'((Lrial— Feaeho brancircirc 7.42 /r 2
Contact namc: B.Fee for branch circuits without
{'� �j service or feeder fee,first
Address: 71 a ,Sw T.ey(ari �'Y/'r,if Rd branch circuit 56.18 I 2
City/State/ZIP: mord l4R / 74701Q3 Each add'I branch circuit 7.42 2
LJ" / Miscellaneous(servke or feeder not included)
Phone:(31 )Cp Fax::( ) Each manufactured or modular 67.84 2
Email: •LI.__rr� _//- �`n/ten/ t/ dwelling,service and/or feeder
t„)�'CX.�IlfMfi',S f"l" My,�/.CO� Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: jhj0. _ Sign or outline lighting 67.84 2
(/'^� Signal circuit(s)or limited-energy
Address: panel.alteration.or extension. ❑ See Page 2 2
•
C1ty/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(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: Electrical Lic.: Suprv.Lie.: specifically listed(Ghrmin)
ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal:ifs6 I0 y
Print name: Date: ❑Plan Review Required(25%of permit fee): —
State surcharge(12%of permit fee): ( L �^17 f
Authorized signalun•i 1 ` TOTAL PERMIT FEE: Gi t6
y" / This permit application expires if a permit h not obtained within 180
Print name:Jo4n ( �/ /r�C� Date: —' � days after It has been accepted as complete.
r �a • Number of inspections allowed per permit.
1:1Ruiling\Perntit1ELC PennitApp-ELR ERE.doc Rev 04/17/2015 4404d15T(11/05/COMAVER
Electrical Permit Application—City of Tigard
Page 2-Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
combined: $75.00 Renewable 1 I Each I Thal •
Fee for all residential systems1
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
O Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
5001 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee ir,accordance
with OAR 918-309-0040) 552.26 2
❑ 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 fce is 90.00/hr
specifically listed('/:hr min)
COMMERCIAL WORK ONLY: ELECTRI PERMIT FEES
SubtoFee for each commercial system: $75.00 •
allowed l
mamntera.
. Page]):
y • Number of inspections allowed per pamdt.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
O Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
[1 Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
C\Duild'near inils\ELC PermilApp_GLR ERE.doc Rev 0G117/2015
Property Owner Statement RECEIVED
Regarding Construction Responsibilities SEP 2 7fl `,
Oregon Law requires residential construction permit applicants who are not licensed with t 1 fY OF 71GAHlj
Construction Contractors Board to sign the following statement before a building permit ca 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.
Xor
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.
a9Art PROP( G;//J'?r s�-
Print Name ermit licant
ignature o Permit Applicant Date
Permit#: CI C. ZO '2-I 0 0 111 5 ,7
Address: 7/Go0 C t'v yLcfi-& �r7
Ck r <_._.Spa
Itti*uvyq r yl
\1
Issued by: v Date: CA`2.1\ZA t'
This Copy for Permit Offices
RECEIVED
�' '' Information Notice to Owners About
' - 1 '`- rya, SEF 2 ND
h,y Construction Responsibilities C FrjGARU
r� 1-, (ORS 701.325 (3)) BUILDIN
G DIVISION
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 1
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.oreaon.gov/ccb
f/property_owner adopted 9-2016 This Copy for Permit