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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2021-00701 Date Issued: 12/13/2021 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 103BC01700 Jurisdiction: Tigard Site address: 12905 SW 121ST AVE Project: Armas Subdivision: CANOGA PARK Lot: 1 Project Description: (1)panel replacement with(19)branch circuits. Contractor: OWNER Owner: ARMAS, JANET 22383 SW LEE DR SHERWOOD, OR 97140 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders-200 12/10/2021 $100.70 Specifics: amps or less 19 crt Branch Circuits w/Purchase 12/10/2021 $140.98 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 12/10/2021 $29.00 Type of Const: Electrical Occupancy Grp: Total $270.68 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 copy of the rules or direct auestions to OUNC by callina 503.232.1987 or 1.800.332.2344. Issued By: Edgardo Matalariada Permittee Signature: y� 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. 9 3 r �i Electrical Permit Application C�'v�� FOR OFFICE r SE 0\1.1 City of Tigard 1 1E Received Permit#: Date/By: ar7/i4,1 L ez.. y_do-7m 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review DateBy: Related Permit# Phone: 503.718.2439 Fax: 503.598.1960 DEC 8��2 �f/ 1ST�1' '"er.1311 Inspection Line: 503.639.4175 Ready Date/By: furls: Id See Page 2 for 1 i t' i`i l Internet: www ttgazd or gov q f T`GPBU Notified/Method: Supplemental Information F,'- re lr; TYPE O W© .:. a f g ''' , $ ,r'' 0 New construction [,Addition/alteration rep-Iacement Please check all that apply(submit a sets of plans w/items checked): ❑Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition ❑Other: where the available fault current ❑Marinas and boatyards. rn s,. N' TEGORY OF COIN • v = :. 1 - ''' exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling 0 Commercial/industrial III .. • . building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder is Other: ❑Fire pump. 0 Installation of 150 KVA or c " '' :::. ' t =':; r ' Emergencysystem' larger separately derived ❑Addition of new motor load of system. Job#: Job site address: I' id 0 y so I a ( ,b V" 100HP or more. ❑"A","E","t-z^,"t-3", City/State/ZIP: ❑Six or more residential units. occupancy. ty /} ❑Recreational vehicle parks. 5 4 c-G 0 —] k 3 0 Health-care facilities. Suite/bldg./apt.#: Project name: ❑Hazardous locations. 0 Supply voltage for more than �� u �� ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: so, f'� ,e�...�-� Fit', lr., L ig, �� . Description Qty. Each Total 1 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#: Ea.add'l 500 sq.ft.or portion 33.92 1 N OFw ,,, y„ If) �� Limited energy,residential }L�i r t (with above sq.ft.) 75.00 2 111 5-trJ`cc( .001 YVke,4`ec-fl t i't'i '1-- Zito Pt fahL� c Limited energy,multi-family 75.00 2 "-'V)t`CQ"I (A© Q' ` i• above sq.ft.) Rene residential able (withEnergy 0 See Page 2 >' ,.,',, . Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 .13 2 Address: 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or chan e,according to ORS 447,449,670,and 70 201 amps to 400 amps 125.08 2 Owner signature: ` (. 1 1, Date: t,� OS ( 401 amps to 599 amps 168.54 2 t Branch circuits—new,alteration,or extension, er panel __ D APPI'fE kN I I.. - - ,; -- A.Fee for branch circuits with Business name: above service or feeder fee, 1 I 7.42 /Lai t 2 each branch circuit 1 Contact name: B.Fee for branch circuits without service or feeder fee,first 56.18 2 Address: branch circuit City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) i Phone:( ) Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 Ins:-:>=Jf;. pi „sr��.€ _� -n €�s���' ,�s;,>,. � ,�_� ,,w, .. ,,� �� _-- �- , _,.�.<,;:_ Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: panel,alteration,or extension. ee Each additional inspection over a owable in any of the above City/State/ZIP: 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 Lic.: Electrical Lic.: Suprv.Lic.: s.ecificall listed('�2 hr min) � y Suprv.Electrician signature,required: Subtotal: a11 i,c,e Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): ;vD 1 Authorized signature: �-_-�--• TOTAL PERMIT FEE: '�70 `cC4_t_. 1 This permit application expires if a permit is not btained within 80 Print name: iltil,,,,u.e 7t 1Date: k/a i3(a days after it has been accepted as complete. ` * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermilApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(1I/05/COM/WEB • Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: Description Each Total Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ 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 50.01 to 100 kva 552.26 2 Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) ❑ Heating, Ventilation and Air Conditioning I Vt)Y7 Solar generation systems in excess of 25 kva: System* No fi(t/ 1),1111)t $„j, Each additional kva over 25 7.42 3 n Vacuum Syste * >100 kva—no additional charge 0.0 3 q c-te �J '��/✓la, 0 Each additional inspection over allowable in any of the above: I Th Other: eA„,) y a c o k I ,me) Each additional inspection is 66.25/hr charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr a �call/ listed 'z hr min) ux :......... Fee for each commercial system: $75.00 Subtotal(Enter Page 1). y * Number of inspections alllowedlowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems LI Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls I I Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations f:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 Electrical Permit Application FOR OFFICE USE ONLI City of Tigard RECEIVED Received Date/B : 1 7 . iL , 8/. ii 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ■ Phone: 503.718.2439 NOV 2 3 2021 Date/B Related Permit#: ' „ '_Ir ,/ Email: TigardBuildingPermits@Tigard-or.gov Ready Date/By: Juris: See Page 2 for T I G A R D Inspection Line: 503.639.4175 Internet: Notified/Method: Supplemental information TYPE OF WOI iLDING DIVISION PLAN REVIEW ❑New construction Addition/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 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. `{-',1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address: 0 ❑Addition of new motor load of system. 5 50a 1,,,e_ 100HP or more.• ❑"A" "E> "1-2" "1-3" City/State/ZIP: ...1-f c� )Q 9 ' " 2 j ❑Six or more residential units. occupancy. q0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: 6 (,k..'V IA0 CA< .e. 0 Hazardous locations. 0 Supply voltage for more than G ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE 5 Lo q ( b e C4CZ Description I Qty. I Each I Total I * r. New residential single-or multi-family dwelling unit. Subdivision: Lot#: l'7 00 Includes attached garage. 1,000 sq.ft.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 ( r (with above sq.ft.) S�r / i_e ✓1 e W OCR _le_ 'yv1 Li t dl Limited energy,multi-family 75.00 2 art ao0A OveciC`e-c- vG2kt e_ 12w t r'e-d 11c'�LA.S residential(with above sq.ft.) +� e' Renewable Energy 0 See Page 2 L l PROPERTY OWNER 0 TENANT Services or feedersall iin ation,alteration,and/or relocation Name: ve. 147r'v 5 200 amps or less 19" ''� ' 100.70 42y 7c:+ 2 V tGv Address: 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: y / ddlrl IA)/t!/v id IPf'Y1 ")1.(VA 601 amps to 1,000 amps 301.04 2 Phone:( ) )t 04 , • Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: - _.._.. :�.. .....__..._._..____...._�- ....--._.._.. relocation Owner installation:This installation is bein m de on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,a 701. 201 amps to 400 amps 125.08 2 Owner signature: i Date: 401 amps to 599 amps 168.54 2 0 APPLICANT ❑ CONTACT PE SON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, each branch circuit 7.42 2 Contact name: B.Fee for branch circuits without {{ bie,`i Z 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:( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: • Reconnect only 67.84 2 n CONTRACTOR /'..( 7Pump or irrigation circle 67.84 2 Business name: 0 4 c r ,/I i `a , 41. a Sign oroutline lighting 67.84 2 C Signal circuit(s)or limited-energy Address: 5 4r,,o � $ c 19 o ye. panel,alteration,or extension. ❑ See Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above AdPhone: 9 7b / 3 G' / 0 5 1 7 / — O 1 - 70 c, Investigation gat inspection(1 hr min) 90.00/hr ( tJ � -1 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('A hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: ,?L /.(9r Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): 141,`!d / i Authorized signature: TOTAL PERMIT FEE: �-)C 6 I J ` ��� ���v� This permit application expires if a permit is not obtained within 180 Print name: e. Date: 2 days after it has been accepted as complete. * Number of inspections allowed per permit. 1:\Building\Permits\ELCPennitApp_ELR_ERE.doc Rev 10/26/2017 4,1-4615T(11/^5/COM/WEB Electrical Permit Application—City of Tigard Page 2-Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Description I Qty. Each I Total I * Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: n Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 n G• arage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 n H• eating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 n Vacuum Systems* >100 kva-no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed('/z hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): 3 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls n Clock Systems n D• ata Telecommunication Installation n F• ire Alarm Installation n H• VAC n Instrumentation ❑ Intercom and Paging Systems n Landscape Irrigation Control* n M• edical n N• urse Calls n O• utdoor Landscape Lighting* n P• rotective Signaling n O• ther: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:ABuitding\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 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 %j 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. ___n--(1-A,t4t—' ican Print Name of Permit Ap7 - 1 / / 10 . / 49'0 Pp Signa re o ermit A licanf Date 9 Permit#: Address: Issued by: Date: 'I This Copy for Permit Offices Property Owner Statement RECEIVED Regarding Construction Responsibilities r ��NOV 2 3 2021 Oregon Law requires residential construction permit applicants who are not licensed with ' OF TIGARLI WY Construction Contractors Board to sign the following statement before a building permit1W -NG DIVISION issued. (ORS 701.325 (2)) This statement is required for residential building,electrical, mechanical, and plumbing permits. Licensed hitect and engineer applicants,exempt from licensing under ORS 701.010 (7), ne, : not submit this tatement.This statement will be filed with the permit. Please check t e appropriate box: j I own, resid\in, or will reside in the completed structure and my gener. contractor is: .\ ' t C r II el a J Name CCB# Expiration Date ,__j I will inform my genera contractor that all subcontractor: who work on the structure must be licensed with the Constr.,ction Contractors Board. or I will be performing work on • operty I own, a •sidence that I reside in, or a residence that I will I / reside in. If I hire subcontracto s, I will hire • y subcontractors licensed with the Construction Contractors Board. If I change ' mind a • hire a general contractor, I will select a contractor who is licensed with the CCB an. will i ediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Inform. ion I ' tice to Homeowners About Construction Responsibilities, and I hereby certify that the informat)dn on thi homeowner statement is true and accurate. (4-#0-1 "\ if I /C1 4 a c Oc Print Name of Permit App li'ant — ItA3i21 Sigryature of Per Applicant Date Pe it#: __ \ Address: \ '•r... w�mip, , .tAroi ;i Issued by: Date: _._ = This Copy for Permit Offices Branden Taggart From: #Building Permit Technicians Sent: Tuesday, December 7, 2021 5:13 PM To: armashilda64@gmail.com Cc: madorinronald@gmail.com Subject: Electrical Permit - 12905 SW 121st Ave. Attachments: ELC_PermitApp_ELR_ERE_061715.pdf; OwnersConstructionResponsibilities.pdf Hello Hilda, With regard to the Electrical Permit Application that you submitted for a permit, the owner's signature is from you, Hilda Armas. However, according to Washington County records,Janet Armas is listed as the owner of the property. For us to proceed with processing this Electrical permit, we will need to have Janet sign the Electrical Permit Application and the Owner Construction Responsibility form. I have attached both forms above. Please let us know if you have questions. Thank you, Branden Taggart n City of Tigard Ili ., Senior Permit Technician Community Development a 13125 SW Hall Blvd Tigard, OR 97223 (503)718-2449 brandent@tigard-or.gov 1