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Permit CITY OF TIGARD ELECTRICAL PERMIT s COMMUNITY DEVELOPMENT ELECTRICAL ELC2021-00412 Date Issued: 9/28/2021 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112BD02500 Jurisdiction: Tigard Site address: 14875 SW 79TH AVE Project: Dodds Subdivision: DURHAM ACRES Lot: 49 Project Description: Replace(1)200 amp or less service and add(2)branch circuits(one for shop out back). Contractor: OWNER Owner: DODDS, RICHARD P DOWNS, MALISSA M 14875 SW 79TH AVE TIGARD, OR 97224 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders-200 09/27/2021 $100.70 Specifics: amps or less 2 crt Branch Circuits w/Purchase 09/27/2021 $14.84 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 09/27/2021 $13.86 Type of Const: Electrical Occupancy Grp: Total $129.40 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{l y Va vt DZ WPge Permittee Signature: Orn.,Aptaticcuti.o-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. Electrical Permit Application FOR OFFICE USE ONLY CityofTigard Receive �/ RECEIVED Date/By /w ZZ/Z/ 42l' Permit#E�.C lam('ti-00 tll 2— , . 13125 III SW Hall Blvd.,Tigard,OR 97223 Pian Review e Phone: 503.718.2439 Fax: 503.598.1960 ' Date/By: Related Permit#: JliL 14 al y Inspection Line: 503.639.4175 Ready Date/By: \ Suds. 55 See Page 2 for I WARD Internet www.tigard-or.gov Notified/Metho77 z�y+., , �J -/C Supplemental Information CITY OF TIGARD vt T E OF 'TIMING DIVISION 9/1-- /"'/C(f '1} PLAN REVIEW ❑New construction ddition/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 ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. [.arid 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural Multi-familyMaster builderOther: amps for all other installations. buildings. 0 ❑ 0 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address: a(� �,- ❑Addition of new motor load of system. /l3 Ts- Jam'y 7y4 100HP or more. ❑ A„ E„ 1.2> '1.3> City/State/ZIP: 7-i 3 7 0 Six or more residential units. occupancy. �/ / ❑Recreational vehicle parks. ❑Health-care facilities. Suite/bldg./apt.#: Project name: j`7eaMe re u Y\ck0 0 Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I QtY. I Each 1 Total I New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: En.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential r / + (with above sq.ft.) 75.00 2 ed+}''v r`✓/iiet e 1(2 rt Lr,f ✓ eii/1 C ne / Limited ener I residential(with above sq.ft.) 75.00 2 AM z atry-i ..5 C]ne e' 1, h i.li ,z Aor eZ.4-LA tic._ PROPERTY OWNER 0 TENANT Renewable Energy ❑ See Page 2 f � Services or feeders installation,alteration,and/or relocation Name: ! G r ri1sZg S 200 amps or less / 100.70 Ald,'7 2 Address: /9.5-7, ,s(...13 7 9:. /6" 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 77j- ...cl, `172`2 601 amps to 1,000 amps 301.04 2 Phone:(, C3)3 9 3 )"7iji"6 Fax: ( ) Over 1,000 amps or volts 552.26 2 44 �� Temporary services or feeders installation,alteration,and/or Email: p S- J. y/Y-N, relocation Owner installation:This installacdon is being made on property that I own which is not 200 amps or less 59.36 I intended for sale,lease,rent or e. han e,according to ORS 447,449,670,�annd 701. 201 amps to 400 amps 125.08 2 Owner signature: _ • Date:7:riic '-'/ 401 amps to 599 amps 168.54 2 PPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: ( -e-- above service or feeder fee, ! D each branch circuit 742 ` / 2 Contact name: B.Fee for branch circuits without Address: service or feeder fee,first 56 t8 2 branch circuit City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone: ( ) Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 / -�t Sign or outline lighting Business name: �1 0 Ail iv �/� g g 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:( ) Fax:( ) Investigation(1 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 Lie.: Suprv.Lie.: specifically listed(A lir nun) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: fiui�=-.5"/ Print name: Date: 0 Plan Review Required(25%of permit fee): %a, '7 0 State surcharge(12%of permit fee): 3 .d''tv Authorized signature: TOTAL PERMIT FEE: X.Z y', 1--/-0 This permit application expires if a permit is not obtained within 1 Print name: Date: 7.._/2 days after it has been accepted as complete. /Y o, ///�� * Number of inspections allowed per permit. I:BuildingTermits\F,LC_PermitApp_ELR_ERE. 06/17/2015 440-4615T(11/05/Co1W WEB Property Owner Statement Regarding Construction Responsibilities 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: L_l I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date i-___I I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. � Sir � 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. /476/e2f i A Print Name of Permit Applicant ., ig%c'r Ø2/ Signa of Permit Applicant Date Permit#: Ei—C Zia 2! —620//Z- /'SF --� W2s SA 7e k -97/cr- /� ,�. Address _--- F ` , m•.Vilkiaiirrf ��.11�wft'' .� ti Issued by: Date: '; _...... .. This Copy for Permit Offices