Permit 71 CITY OF TIGARD ELECTRICAL PERMIT
■ COMMUNITY DEVELOPMENT Permit#: ELC2022-00138
Date Issued: 3/7/2022
T f O A R i) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 25111 C601741
Jurisdiction: Tigard
Site address: 10455 SW HOODVIEW DR
Project: Nelson Subdivision: HOOD VIEW NO.2 Lot: 40
Project Description: Replace old electrical panel.
Contractor: OWNER Owner: NELSON, JAMES R& LINDA S
10455 SW HOODVIEW DR
TIGARD, OR 97224
PHONE:
PHONE:
FAX: FEES
Quantity Description Date Amount
1 ea Services or Feeders-201 to 03/07/2022 $133.56
Specifics: 400 amps
1 ea 12%State Surcharge- 03/07/2022 $16.03
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $149.59
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 callina 503.232.1987 or 1.800.332.2344_
Issued By: Ea Malctov,.adv Permittee Signature: 5,--c-0.1 e'`'"
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
Received -on 5e.
City of Tigardid 97223 D 0 12 Pcnnit ff: C��
y 13125 SW Hall Blvd.,Tigard,OR y
p `�'1, eview Related Permit#:
Phone: 503.7182439 Fax: 503.598.1960 ��v�� Ie/By:
Inspection Line: 503.639.4175 Ready Dare/By: inns` See Page 2 for
TIGARD Internet: wwwtigardorgov NAR 2- 2021 Notified/Method: Supplemental Information
TYPE OF WORK -__ - PLAN REVIEW
ElNew construction jgj Addition/8iteration/rCpiadYi/�{' O r TIl�llt GnIlD Please check all that apply(submit a sets of plans w/items checked): -- -
❑ ❑ BUILDING DIVISION ❑Service or feeder 440 amps or more ❑Building over three stories.
Demolition Other: where the available fault current 0 Matins and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
RI I-and 2-family dwelling ElCommercial/industrial El Accessory building dens to ground,or exceeds to two ❑eo,e,� ial-nse agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fite pump. ❑installation of 150 KV A or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: _ Job site address: /O q,S ry&_//oo 1 ee )/l 0 Addition of ornee.motor load of system.
tJ Y IDOIIP or more. ❑"A""L•• `I_2""1_3•,
Ct[ /$tate/ZIP: ❑Six or more residential units. occupancy.
Y �7�j 1°� 0 Recreational vehicle parks.
! i r �.//S/1. --. ❑Ftealtl�'e facilities.
Suite/bldg./apt#: Project name: 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
- ua---- sn I air- 1 r.rr I Teel 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'!500 sq.ft or portion 33.92 1
DESCRIPTION OF WORK
Limited energy,residential
75.00 Z
M14/f1 G>Q L d C7'C/PiG Y�-{' per-l/ (with above sq.ft.)I Limited energy,multi-family 7s.00 z
-- -------- - residential(with above sq.ft.)
A PROPERTY OWNER ❑ TENANT Renewable or feedersnergy
0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: ci7 O'4oS ) (��.S�h 200 amps or less 100.70 2
Address: / 20i dtnpa to 400 amps 133.56 2
ioys's- sacs_ f,/_vdv/ct.� /�2
_.-- .. 401 amps to(100 amps 20034 2
City/State/ZIP: 7. , e� KQ -3 601 amps to 1,000 amps 301.04 2
Phone:($a3) 8'8/J— ovic 4, Fax:( ) Over 1,000 amps or volts 552.26 2
- - -- - ------ Temporary services or feeders installation,alteration,and/or
Email: , s,/SGn )4 sie / d r r e"Q/Ai 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,rem char cor ' to 447,449,670,a 201 amps to 400 amps 125.08 2
Owner signature: G 1Cl/ ••••- Date: ‘...?..-'1 401 amps to 599 amps 168.54 2
-- -. - ---. - -_ Branch circuits-new,alteration,ar eafenalon,per pane)
❑ APPL NT ❑ CONTACT PERSON . A.A.Fee for branch circuits with _--- -
Business name: above service or feeder fie,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without --
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'!branch circuit 7.42 2
-- Miscellaneous(service or feeder not included)
Phone:( ) I Fax::I. ) Each manufactured or modular
67.8.4 2- dwelling service and/or feeder
Email: ...Reconnect only 67.84 2
CONTRACTOR
Pump or irrigation circle 67.84.. .. 2
Business name: Sign or outline lighting 67.84 2
- limited-energy
Address Signal circuit(s)orexension.
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(I hr min) 90.00/hr
Email: Industrial Pleat(l In min) 78.18/hr
__.. _.... __ Inspections for which to fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lie.: specifically listed(%hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 03.
Print name: I Date: ❑Plan Review Required(25%of permit fee):
-- - -- State surcharge(12%of permit fee): ` e)
Authorized signature: TOTAL PERMIT FEE: /1/1.j,
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.
LIB,dldiagiermits\ELC_PeonkApp_ELR_F'P.dor Rev 06/17/2015 440-4615T(11/05/COM/WEB
Property Owner Statement
Regarding Construction Responsibilities OAR 2 2fl2Z
Oregon Law requires residential construction permit applicants who are not licensed with-tl}e, F TI�iA�lt
Construction Contractors Board to sign the following statement before a building permit can b+e
issued. (ORS 701.325 (2)) !G DIVISION� . .
This statement Is required for residential building,electrical,mechanical,and plumbing permits.
4, _, 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.
"P Please check the appropriate box:
,i I own, reside in,or will reside in the completed structure and my general contractor is:
;; Name CC04 Expiration Date
t%._
-
I I wilt inform my general contractor that all subcontractors who work on the structure must be
F,t , ,licensed wi � 0 Co Bttructlof Contractors Board.
„� is tty I awn, a residence that I reside in, or a residence that I will
' ,r rea de`in."1f€hire stibcantrRctor,I will hire only subcontractors lIcensed with the Construction
It '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
L s d 1 ,01•a i1. ,Z e r m= t1,1 ) x. rv' s t,
sti v e 2i ,K .r1 § nxt-✓F k i .r' el-i: i4rn i r
�' mth vs a un nd oInter i ton Notice to Homeowners About Construction Responsibilities,
w; i1� d, rF�.
' `1'} , 9J _{ , „_,Jt'!4 ',p(; '',, f,.t31..f^ „•z.,,.a_..#a homeowner statement Is true and accurate.
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