Permit CITY OF TIGARD ELECTRICAL PERMIT
91 s_ COMMUNITY DEVELOPMENT Permit#: ELC2022-00241
Date Issued: 4/14/2022
T J G A,g D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103AA01907
Jurisdiction: Tigard
Site address: 12325 SW 106TH DR
Project: TORKKO Subdivision: COTTONWOOD PLACE Lot: 10
Project Description: (1)branch circuit for fireplace insert fan.
Contractor: OWNER Owner: TORKKO, HEIDI
12325 SW 106TH DR
TIGARD, OR 97223
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 04/14/2022 $56.18
Specifics:
Service or Feeder
1 ea 12% State Surcharge- 04/14/2022 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total S62.92
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 issu nce, or if work is suspended for more the
180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility ification ente ose rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may in f the rules or direct auestions to OUNC by callina 503 . 87 0 1. 00 .23 4.
Issued By: ? � oh Permittee Signature: l
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 FOR OFFICE USE ONLY
City of Tigard RECEIVE i!� -�iI '111 • 13125 SW Hall Blvd.,Tigard,OR 97223 Flan Review
Phone: 503.718.2439 Date/B : Related Permit#:
T I G A R D Email: TigardBuildingPermits@Tigard-or.gov PR 1 4' 2022 Ready Date/By: Eris' 10 See Page 2 for
Inspection Line: 503.639.4175 Internet: www.tlgar -or.gov Notified/Method: -7,--( Supplemental Information
TYPE OF WORK CITY OF TIGAHLI PLAN REVIEW
❑ New construction [,Addition/alteration/ 1 ( r)IVlSIOf l'Icasc check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
.a
b. I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: I Job site address: I232S5 S(,. ) IV 1..,-INA.""D 2. 100HP or more, ❑"A","E","I-z","t-3",
City/State/ZIP: /�F� 1 9 223 ❑Six or more residential units. R creation.
"_ z�lr El Health-carefacilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 715 ru0(D 0 Hazardous locations. 0 Supply voltage for more than
� ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: W LA ' , FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'I 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
I I�,./ '�'� OL-2—�7 f p x A c L i'I 10 R� (with above sq.fl.)
75.00 2
t� Limited energy,multi-family
I> 10 Q 'F D —nt—11 i a(11(2— :
) y—+ - t� 11 G/- ` residential(with above sq.ft.) 75.00 2
I-- ll` t 121'I \�J tom+ — 1`� lv e� Renewable Energy 0 See Page 2
PROPERTY" OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: a.E. 01 KE) 200 amps or less 100.70 2
Address: `23 z ' -n-L "D2 201 amps to 400 amps 133.56 2
ty Co J�2/ / oP '4
-1 2-� amps
401
amps to 600 0 200.34 2
City/State/ZIP: / (
J'� l/1 601 amps to 1,000 am 301.04 2
Phone:(93) 3 c I- 9 1 Over 1,000 amps or volts 552.26 2
t I J � Temporary services or feeders installation,alteration,and/or
Email: AP:"a 1 C'Ilei1. L Art „4 relocation
Owner inst: : ton ' i• in Al :'.n is r,''ng made on property at I own whetsis of.6 200 amps or less 59.36 1
intended f' sale,I::.- re $ chan according to ORS 447,449,670, d 01. 201 amps to 400 amps 125.08 2
Owner sig •ture: �,//li�►� / Date: 21-- 401 amps to 599 amps 168.54 2
41.-'I•PLIC:. j 0 CONTACT PERSON
Branch circuits—new,alteration,or extension, r er panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
, ,., � ^ each branch circuit 7.422
Contact name: / .,L vyy).(-)A4 ` B.Fee for branch circuits without
Address: service or feeder fee,first
1 23 ZSS >'n lL) IOU, -I-bl �(L branch circuit 56.18 {.9 2
City/State/ZIP: " � (L 9-7Z2.3 Each add'I branch circuit 7.42 U 2
Miscellaneous(service or feeder not included)
Phone:(c1:5' 32_0-3132 g Each manufactured or modular 67.84 2
�l ' dwelling,service and/or feeder
Email: lfj}A 2 l r p3 1Y- ( s C19,4- . Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
t y o ne ('
Address: Signalel,aclteration,
n or extension. 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(I hr min) 78.18/hr
Email:
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.Electrician signature,required: Subtotal: >?P,t Y
Print name: Date: ❑Plan Review Required(25%of permit fee):
Slate surcharge(12%of permit fee): , )i.1
Authorized signature: TOTAL PERMIT FEE: ((a Ai.
This permit application expires if a permit is not obtaiaeiwithin 180
Print name: Date: days after It has been accepted as complete.
* Number of inspections allowed per permit.
l iluildingPermits\ELC_PesmitApp ELR_ERE.doc Rev 10/26/2017 440-4615T(11 i05/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. I Each I 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 to25 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* >I00 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ 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:
n 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('L hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ 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:\Buitding'Permits\ELC_PemitApp_ELR_ERE.doc Rev 1 012 6/201 7
Property Owner Statement x
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)j
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
•
j I own, reside in, or will reside in the completed structure and my general contractor is:
••
NameGCB# Expiration Date
l I Will inform my general contractor that all subcontractors who work on the structure must be
linensed with the Construction Contractors Board.
I will be performing work on property I own, a residence that I reside in, or a residence that I will ,
fff��� 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 wilt select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing thil Building Permit
t
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.
U
Pr.r,t�ia \
r 2 rrnaApplicant
kirk
Ft
c ' 1 _f f 'G2
Slg$atur of milApptnant Data
Permit#.
R
ti Address "1:`'::
7""" Wrfr;:r 0
r •iurarh..
Issued by: Date: f-
t a ° ;tr.-W. cif , : :