Report CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit#: ELC2021-00651
Date Issued: 11/10/2021
'T f GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104BA07200
Jurisdiction: Tigard
Site address: 14030 SW LIDEN DR
Project: EVANS Subdivision: CASTLE HILL NO.2 Lot: 107
Project Description: (3)branch circuits for furnace,A/C,and lighting.
Contractor: OWNER Owner: EVANS, DAVID J&ALLE M
14030 SW LIDEN DR
TIGARD, OR 97223
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 11/10/2021 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 11/10/2021 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 throua R 952-001-0090. Yobtain a coov- rules or direct auestions to OUNC by calling 503.2 87 1.800.332.2344.
Issued By: r Permittee Signature: /'' �'1
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 ii
PCEIVE 1 OR 01.1.R.E t ,sr.()NI:1
City of Tigard Received 1,i o
Date/Bc111 )1 /kr ,Permit#:ri ,oat-octil
..,,4 13125 SW Hall Blvd.,Tigard,OR 97223
1 tir' Phone: 503.718.2439 Fax: 503.598.1960
, OCT 2 8 ZO21
Plan Revier, /17-
Date/137: Related Permit il:,/1K-'...1...9.-1147.1_00 V11418
Inspection Line: 503.639.4175 .}i 1 1 OF TIGARD Ready Datell3y: 7/ Turis: 55 SeevPage 2 far
1 D:-"AR D Internet www.tigard-or.gov N ode& : ii5 2.1 itjr)'Pt" Supplemental Information
qpINGDIvisioN—v-°"edim .......„ .....
TYPE OF WORK (V 6-0-14..,+.4.4 44444 PLAN REVIEW
0
0 New construction A Addition/alteration/replacement Please check all that apply(submit/sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
El Demolition El Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
r I-and 2-family dwelling El 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 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address: 14030 SW!idea Dr. 100HP or more. 0"A","E","1-2","1-3",
0 Six or more residential units. occuany.
City/State/ZIP: Tigard, OR 97223 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bIdg./apt#: Project name: F vans 0 Hazardous locations. 0 Supply voltage for more than
,_— -, .._„„„,... El Service or feeder 600 amps or more. 600 wIls nominal-
Cross street/directinns to job site: FEE SCHEDULE
3 1 6 6 z w...4 1,,, „ _.. oacrie.a. _Ltel,L„,,E.-ch ,I Total I •
L,u,..4:.:" New residential single-or multi-family dwelling unit.
6 ' ,,,,46.1((. 0ePte, ' /I/ 4 ' -
Subdivision: Castle Hill Lot# "I 0 7 Includes attached garage.
1,000 sq.ft.or less 1 /68.54 — ! 4
Tax map/parcel#:
— Ea.add'l 500 sq.ft.or portion 33.92 , 1
DESCRIPTION OF WORK Limiter!energy,residential
-- ---- 7
I with above .ft.i
Furnace Replacement in 2017(Unknown cont 5.00 2ractor), ,
Limited energy,multi-family
Cosmetic updates toTitonen, Hathrooms,anti upnatet I Iv Txtures. residential i vvith above vfi.fl.) 75.00
, — - Renewable Ellett)/ ___-...Ci Se P4.5.2 - 1-2
ril PROPERTY OWNER 1 in TENANT Services or feeders installa n,tion,alteratio and/or relocation
Name: David Evans 200 amps or less 1 100.70 2
--- .
201 amps to 400 amps 133.56 2
Address: 14030 SW Liden Dr
-- , 401 amps to 600 amps 200.34 2
City/State/ZIP: Tigard, OR 97223 601 amps to 1,000 amps .,.,
301.04
2
. - ..,
Phone:(503 )488-9209 Fax:( ) Over 1,000 am 552.26 snips or volts 2
— . • Temporary services or feeders installation,alteration,and/or
Email: Davidlevans4 grnaitcom relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 snips to 400 amps 125.08 2
Owner signature: David Evans nia:°5SF":"----- Date: 1 1/3/21 401 amps to 599 amps 168.54 2
- ..,
. .
E3] APPLICANT I. f23 CONTACT PERSON Branch circuits-new,alteration,or extension,per paael
A.Fee for branch circuits with
Business name: above service or feeder fee, .....3 ' 2
each branch circuit .. ,..
Contact name: David Evans B.Fee for branch circuits withe
----- ". service or feeder fee, I
Address: 14030 SW Liden Dr. branch circuit first 56.18 43107.,it 2
—
City/State/ZIP: Tigard, OR 97223 Each add'I branch circuit a ,,,3--"" 7.42 lit.111 2
Miscellaneous Iservice or feeder not included
Phone:(503)488-9209 Fax::( ) Each manufactured or modular 67.84 2
dwellina.service and/or feeder
Email: davidjevans4@gmail.corn — _ Reconnect only Ili 67.84 2
.... .......... —„
CONTRACTOR Pump or irrigntion.‘oircie M 67.84 2
.. ..
Business name:Onknown/Owner Sign or outline lighting Eli 67.84 2
- — Signal circuit(s)or limited-energy 2
Address: ,...knel_alterati. or extension. 0 See Page 2 '
, _
Each additional insmtion over allowable in any of the above
City/State/ZIP:
-' Additional inspection(1 hr min) ' 66.25/hr
Phone:( ) tfax:( ) Investigation(1 hr min) 90.00/hr
— Industrial plant(1 hr tnin) 78.18/hr
Email: — - — Inspections for which no fee is /h
CCB Lie.: Electrical Lie.: lauprv.Lie.: specifically listed Oi hr mint 90.00 r
- --- ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: -7 i-01
..,
Print name: Date: 0 Plan Review Required(25%of permit fee): —
_ State surcharge(12%of permit fee):
—
grcz.......,........ .
Authorized signature: David Evans,—.------ TOTAL PERMIT FEE '1 j,
rn- Doweacel,t0 3 1 It 6.4.017
,.... """" '."---... ills permit application ezifreall;;;;;Iiit Is not Mined witbM-180
Print name: David Evans Date: 10/28/21 days after it has been accepted as complete.
- — • Number of inspections allowed per permit
PABuitchneermits WIC PermitApp_EIR ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
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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:
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 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.
'br„j Tuct4c.
Print Name of Permit Applicant
1)/i /Z
Signature o Permit Applicant Date
Permit#: FCC: j 2-1 "Ck)j s o_F
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Address: /1/G>S'.: G /
, cl-ty �� Y. • - mr,A;\�0
Issued by: - Date: /AA/ I
This Copy for Permit Offices