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Permit CITY OF TIGARD ELECTRICAL PERMIT " DEVELOPMENT `=' COMMUNITY DEVE Permit#: ELC2021-00715 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12120/2021 Parcel: 2S102AB01300 Jurisdiction: Tigard Site address: 9315 SW COMMERCIAL ST Project: Nydigger Subdivision:RTH TIGARDVILLE ADDITION,AMENC Lot: 64 Project Description: Replacing(1)200 amp meter base and panel in addition to(10)branch circu is for bathroom and office remodel. Contractor: OWNER Owner: NYC IGGER, MARK A&YVONNE K 12630 SW PATHFINDER CT TIGARD, OR 97223 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders-200 12/16/2021 $100.70 Specifics:, amps or less 10 crt Branch Circuits w/Purchase 12/16/2021 $74.20 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 12/16/2021 $20.99 Type of Const: Electrical Occupancy Grp: Total $195.89 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specially 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 coov of the rules or direct auestions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: egi.es-finL., ..- �% Permittee Signature: Ci —°. ,,a ";-`./r'f "' 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. 1t EIVECO Electrical Permit Applicat o FOR OFFICE USE ONLY City of Tigard DEC 2 2021 Received 1� L�(?t Permit#: �-' . �a�l+ —i)r 5— Dan R , 1�t,�rOW III R 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review _ Phone: 503.718.2439 Fax: 503.598jb ( OF fIGAI-L Date/By: A/ Related Permit#: /jt _d., 1 L77 Inspection Line: 503.639.4175 BUILDING DIVISION Ready Date/By: i -/1� luris� ' / Supplemental See e PPagge 2 or _! TIGARD Internet: www.tigard-or.gov Notified/Methhhod:__ Su lementalInformation TYPE`OF WORK dr +"K AAA.., PLAN REVIEW 0 New construction 41KAddition/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. Xf 1-and 2-familydwellingCommercial/industrialless to ground,or exceeds 14,000 0 Commercial-use agricultural ❑ 0Accessory building amps for ell other installations. buildings. ❑Multi-family 0 Master builder 0 Other: 0 Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: l Job site address: 93 j�S s W �Mt�� q\ �„t ❑Addition f rnnew motor load of system. CGS T 100HP or more. ❑"A" "E","1-2","1-3", ❑Six or more residential units. occupancy. City/State/ZIP: 4 i,q A f A 8 ( (A 7 Recreational vehicle parks. V 1 �� 0Health-care facilities. 0 Suite/bldg./apt.#: I Project name: 0 Hazardotu locations. 0 Supply voltage for more than 0 Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: ,K ts 1 t� L'I n`�1 FEE SCHEDULE }, v 1 Description I Qty. 1 Each 1 Total I * J lrl CL -\ S Zl1 \I 6,c A �tlS'\' Q A (nfn%I\ 1 New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax snap/parcel#: Ea.add'1500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energ y,residential 75.00 2 9.t.91A (with above sq.ft.) � C.� ��d AN) M2 1��� L>,r rAt. Limited energy,multi-family residential(with above sq.ft.) 75.00 2 Renewable Energy 0 See Page 2 PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation Name: 1(` \A \ "�J t .Q( 200 amps or less / 100.70 t4)-7 2 Address: 1�63v cs ti� 9 GN 11.J �J 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP:-f- fcm A 0 t G•� � 601 amps to�,000 amps 301.04 2 Phone:�ca) 7 o b7] 6 1 Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: .M (Vd t it k(c co(v\ S , na relocation Owner installah :Th' stallation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,ore h e,according to ORS 447,449,670,and 701. 201 amps to L00 amps 125.08 2 Owner signature: 7 7� Date:1�—2.�' 401 amps to!99 amps 168.54 2 (f APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: AM above service or feeder fee, l 1 j + each branch circuit 4 7.42 2 Contact name: �C)[' (V�J ( B.Fee for branch circuits without Address: 12,t3 0 �vi Po,\AN j� CA. service it f eeder fee,first 56.18 2 `' branch circuit City/State/ZIP: a;A O 7 y�� Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(s 3) •fib.+ i a Fax::( ) Each manufactured or modular 67.84 2 Email: � C3 ] dwelling,service and/or feeder V Cf t�f ( co4041 {��. (e (� Reconnect only 67.84 2 V V V tONTRAC OR Pump or irrigation circle 67.84 2 Business name: H d 0\c. ©v‘i Ai c o 1 n t)W y\ Q.,e.Cy11 %LA) Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: panel,alteration,or extension. ❑ 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 Irr min) 90.00/hr Email: Industrial plan (1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically lis'ed('%hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: l-7L1.V Print name: Date: 0 Plan Revi sw Required(25%of permit fee): /f State surcharge(12%of permit fee): Al �'4///7 TOTAL PERMIT FEE: S Authorized signature: 7 i��� j ^ This permit application expires if a permit is not obtained within 180 Print name: ' ► \arc 6/d \Ay t f Date: I j,_' Z. J days after it has been accepted as complete. * Number of irspections allowed per permit. I:1Building\Pei mits\ELC_PermitApp ELR_ERE.doc Rev 06/17/2015 440-4615T(II/05/COM/WEB err Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: FEE SCHEDULE RESIDENTIAL WORK ONLY: Description I Qty. 1 Each Total I Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 5 kva or less 100.70 2 Check Type of Work Involved: 5.01 to is 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 D Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) ❑ Heating,Ventilation and Air Conditioning (k, • Solar generation systems in excess of 25 kva: System* rfl) I? 1 Each additional kva over 25 7.42 3 Vacuum Systems* �' �'li >100kva—no additional charge 0.0 3 1_ �' r / �(a •� Each additional inspection over allowable in any of the above: P =��hC-� �J additionalainspection (1it is 66.25/hr 1 O er: ,k( • charged at an hourly hr min) Inspections for which no fee is 90.00/hr specifically listed('A lu•min) FT,FCTRICAL PERMIT FEES COMMERCIAL WORK ONLY: Subtotal(Enter on Page I): Fee for each commercial system: $75.00 * Number of inspections allowed 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 n HVAC Cl Instrumentation ❑ Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: — *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR ERE.doc Rev 06/17/2015 AMOY RECEIVED Property Owner Statement DEC 22021 Regarding Construction Responsibilities CITYOFTIGARb Oregon Law requires residential construction permit applicants who are not licensed withLDING DIVISION 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 gereral 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 XI will be performing work on property I own, a residence that I reside in, or a residence that I will If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors reside in. Board. If I change my mind and hire au 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. (Vttic-0 Print Name of Permit plicarr Signature of Permit A ica Date Permit#: i/f-) ?l—0 7/S 13/5- c5L.1 i J } Address: Ir7�, �' ��,���,��ii�, •�� . Ord Issued by: 4,,i Date: 4; 1 This Copy for Permit Offices