Permit *1111 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Per
COMMUNITY ELC2022-00036
T[G A R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 1/19/2022
Parcel: 2S 111 CC20700
Jurisdiction: Tigard
Site address: 15650 SW GREENLEAF CT
Project: Miller Subdivision: SUMMERFIELD NO.5
Lot: 265
Project Description: Replace existing 100 amp feeder with new 100 amp feeder
Contractor: OWNER Owner: MILLER, DIANA L LIVING TRUST
15650 SW GREENLEAF CT
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 01/18/2022 $100.70
Specifics:
amps or less
1 ea 12%State Surcharge- 01/18/2022 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 throuch 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: 1-10-U4./ Va ,De,Wege, Permittee Signature: 0I^'A
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 1 oR O, , ,( , , s, Oy1 l
City of Tigard RECEIVE IF'awed
Da i 1\$k22 �v Permit#:a ZoZ2.-0003(D
IIII ei 13125 SW Hall Blvd.,Tigard,OR 97223 n Re
= Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 JA N 1 a 7072 Date/By: Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: t\\esl75 e. y( runs: I See Page 2 for
I IC AKll Internet: www.tigard-or.gov CITY OF TIGAR[ Notified/Method: c1iAr1•ti Supplemental Information
TYPE OF WORN UILDING DIVISinr, 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 0 Accessory building less to ground,or exc.-Ms 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
El Multi-family ❑Master builder ❑Other: 0 Fire pump.
JOB SITE INFORMATION AND LOCATION ['Emergency system 0 larger
separately Installationof 150 rderivedVA or
Job#: Job site address: „'`` � './!�_ / �L ❑Addition of new motor load of system.
If4J2) sw t reentalc e • 100HPormore. ❑ A, `E, 1_2 ,`1_3„
City/State/ZIP: nQ.(a`D J� Y�1� 0 Health-care
or more residential i. units. occupancy.
`� ,\ !Ot Health care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
(� �1 ❑Service or feeder 600 amps or more_ 600 volts nominal_
Cross street/directions to job site: SJm rr er-F i e Id Dr, T-',T Q of FEE SCHEDULE
Ur ham 'Rd• Description I Qty. I Each I Total I :
��(-� New residential single-or multi-family dwelling unit.
Subdivision: S J motto I 'fits I �� Lot#:Prali Includes attached garage.
u7 rt �/ 1,000 sq.ft.or less 168.54 4
Tax map/parcel#: €l5 f I I CC 020 A/0Q
Ea.add'i 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK �j�j��� ��,y Limited energy,residential
!�° 1 oo ` .t/64c/J /t _ c '.� e r i ,,. (with above sq.ft.) 75.00 2
LK Limited energy,multi-family 75.00
2
P4, '( ,. /00 /"l,yh`/l �Qd c residential(with above sq.ft.)
'' ' � Renewable Energy ❑ See Page 2
V. PROPERTY OWNER 0 TENANT
Services or feeders installation,alteration,and/or relocation
Name: D(3\ K w ilex- 200 amps or less \ 100.70 e(:0.—I 2
Address: i'(p'v S'IA1 &r 11 d e4.P �,Jam• 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: -6, arc( Oi q 1 601 amps to 1,000 amps 301.04 2
Phone:(,�03) er g El, '5,'i/ I Fax:( ) Over 1,000 amps or volts 552.26 2
� Temporary services or feeders installation,alteration,and/or
Email: di COV- 1 I(ec 1 Co e s4-L, fe j' 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 exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: W t QmC1_ 4 L -- Date: 111 3(ate 401 amps to 599 amps 168.54 2
Branch circuits—new,alteration,or extension,per panel 0 APPLICANT El CONTACT PERSON
A.Fee for branch circuits with
Business name: above service or feeder fee, 7.42
each branch circuit
Contact name: '0 I c f�17 a l'1 a ((e r- B.Fee for branch circuits without
se4.J 0 S u! �y r e /� /l branch it feeder fee,first 56.18 2
Address: lrJ ` L,l
n Q��' l branch circuit
City/State/ZIP: I l' Q rd, a R7a a 4 Each add'l branch circuit 7.42 2
/ Miscellaneous(service or feeder not included)
Phone:('o3) g o64-,a gto, Fax::( ) Each manufactured or modular
ry , j. dwelling service and/or feeder 67.84 2
Email: d iana m I ( ie r- l� &Cowl Ca S-E flu { Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: (?w' 6 do 0) Sign or outline lighting 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 is90.00/
lir
CCB Lic.: Electrical Lic.: Suprv.Lie.: specifically listed(Y2 hr mite)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev06/17/2015 440-4615T(11/05/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 Qh- I 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:
5.01to15kva 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)
O 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 any of the above:
❑ Other. Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90 00/hr
specifically listed(%2 hr min)
COMMERCIAL WORK ONLY: ELECFR1CALL PERMIT'FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page I):
y * Number of incpr�tions allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
0 Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ M• edical
❑ Nurse Calls
[1 O• utdoor Landscape Lighting*
❑ Protective Signaling
❑ O• ther:
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
Property Owner Statement RECEIVED
Regarding Construction Responsibilities ,N 1 8 2077
Oregon Law requires residential construction permit applicants who are not licenseyftWdyfttAAD
Construction Contractors Board to sign the following statement before a building pEI(glikiflan1 IQ1\;
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 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.
Of
f 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.
i 1er
Print Name of Permit Applicant
•
C-2Lalia Alta
Signature of Permit Applicant Date
Permit* •
— o-F
Address: ,., ,
*** :'
Issued by: Date: = 5
This Copy for Permit Offices