Permit CITY OF TIGARD ELECTRICAL PERMIT
ip,„
S o Permit#: ELC2021-00714
COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 1/27/2022
Parcel: 2S104AC06300
Jurisdiction: Tigard
Site address: 12452 SW 133RD AVE
Project: Secretary of Housing& Urban Development Subdivision: MORNING HILL NO.8 Lot: 207
Project Description: Reconnect only.
Contractor: Owner: USA SECRETARY OF HOUSING& URBAN DEVE
BY ISN CORP-WESTERN OPERATIONS
CENTER
SHEPHERD MALL OFFICE COMPLEX
2401 NW 23RD ST STE 1 D
OKLAHOMA CITY, OK 73107
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 01/25/2022 $67.84
Specifics: 1 ea 12%State Surcharge- 01/25/2022 $8.14
Type of Use: SF Electrical
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
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: Ho ci Vc14 Pe,We9e, Permittee Signature: Or'"Apptit-cutizrvv
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 503.639.4176 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.
D
Electrical Permit Applicati "EIV" FOR OFFICE USE ONLY
17City of Tigard DEC 8 ZUY! RecDate/By: Q/ii -al Permit": ELc8 (,7<y i
1 13125 SW Hall Blvd.,Tigard,OR 9727r Plan Review Related Permit N:
Phone: 503.718.2439 Fax: 503.598 OFTIGARG Date/By: /v,�9 /1SV-1z)21 -0/0Lik,1
Inspection Line: 503.639.4175 Ready Date/By: / lurid _ H Ace Page 2 for
TI GARI) Internet: www.ligard-or.guv 3UILDING DIVISION Notified/Method: V/1577/ j 1�(7C Supplemental Information
TYPE OF WORK &ati-ut(--.1 7)ar✓I ,' PLAN REVIEW
❑New construction D Addition/alteration/replacement Please check all that apply(submit 2 sets of plans wlirems checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
E]Demolition 0 Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
y0l-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to gmuml,or exceeds 14,000 0 Commercial-use agricultural
strips for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pinup. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION
LOCATION p 0 Emergency system. larger separately derived
Job#: Job site address: ',�5 a 133 r-gliq M 0 Addition of new motor load of system.
��, sw VVee// 7Ill�.r I00HPormore. ❑••A•,,"E•,,••I_2",••I_3„
City/State/ZIP: ❑Six or more residential units. occupancy
ty T 1 5 a r d d(� a`7 A. 3 ❑Health care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
V`^"'% r CPI: "'"?�`4,5'11 ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: 01 �t.6YN7 . - "f'may- FEE SCHEDULE
Description I Qty. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: M e n•1 n 'S 1 No . B Lot#: '1['a o r/ Includes attached garage.
Tax map/parcel#: a Q p) 0 1,000 sq.R.or less 168.54 4
Fa.aold'l 500 sq.(t.or portion 33.92 1
r� DESCRIPTION Oy/F��W�OR/IKf��� -}� -y� Limited energy,residential
/UM tX $um i :r Safe `Ds � `r E torn 1 r e (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
Po 1, r be. O 1 • residential(with above sq.0.)
w CJPItOPERTY OWNER Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: 200 amps or Less 100.70 . 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 5936 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: Date: 401 amps to 599 amps 168.54 2
APPLICANT j fCONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: R eistl4't 9 above service or feeder fec, 7.42 2
each branch circuit
Contact name:'-v A i M, \eA (D a B.Fee for branch circuits without
Address: a 3 E D N E t D ,,,, , J service ocircuit
feederuitfee,first 56.18 2
Q a/'� (�, branch circuit
City/State/ZIP: ' >>Sbp o 1 ! ?91 -.- Each add'l branch circuit 7.42 2
`^ 5� Miscellaneous(service or feeder not Included)
Phone:�/X t 8 I Fax::( ) Each rnarmthcmred or modular
r VV:^--11f ,n e' �C dwelling,service and/or feeder 67.84 2
Email: ton', o l+et N d0011 5 Q a,01• Reconnect only X 67.84 �7 a 2
1 CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: panel,alteration,or extension.
C1ty/StatdZlP: Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/br
Phone:( ) I 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 Lie.: I Electrical Lic.: I Suprv.Lie.: specifically listed(i hr min)
ELECTRICAL PERMIT FEES
Suprv.Elec." tan signature,required: Subtotal: G')II
Print n:,•e: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): F.,(I.)
Au I orized signature: e -6n..k.1 flitk . t\O `4 WV' TOTAL PERMIT FEE:
��r, _�}/ This permit application expires If a permit is not obtained within 120
Print name:--r h, M W `n qt. y p v Date: I _aQ a t days after it has been accepted as complete.
z'l la
'IrF-A • Number of Inspections allowed per permit.
I:t0udding\PermcatELC_PermitApp_FJR_ERE.doc Rev 06/17 5 44114615ty11/05/COWWES
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Descri combined: $75.00 aa I �r I Each I Total I
•
Fee for all residential systems
Renewable electrical energy systems:
Check Type of Work Involved: s kva aless 100.70 2
5.01 to 15 kva 13336 2
O Audio and Stereo Systems* 15.01 to25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
0 Garage Door Opener* 50.01 to 100 kva 552 26 2
100 kva(fee in accordance 55226 2
with OAR 918-309-0040)
n Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems*�O / l/ >100 kva-no additional charge 0.0 3
`� p Each additional inspection over allowable in any of the above:
lv l Other aS tL t/„�"n �ns 4(� o ML 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('h hr mini)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
y • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
0 Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
0 Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
l:�Buadmg\ mits'nC_PennitApp_ELRERE.doe Rev 06/17/2015