Permit CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT
Permit#: ELC2022-00328
Date Issued: 5/23/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S125DB04400
Jurisdiction: Tigard
Site address: 7160 SW TAYLORS FERRY RD
Project: SALCE Subdivision: SHADY DELL NO.2 Lot: 18
Project Description: Electrical panel replacement and(5)branch circuits.
Contractor: PHOTO ELECTRIC LLC Owner: SALCE, LINDA&MATTHEW
PO BOX 13657 7160 SW TAYLORS FERRY RD
SALEM, OR 97309 TIGARD, OR 97223
PHONE:
PHONE: 503-551-9611
FAX: 503-375-9829
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 05/23/2022 $100.70
Specifics: amps or less
5 cet Branch Circuits w/Purchase 05/23/2022 $37.10
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge- 05/23/2022 $16.54
Type of Const: Electrical
Occupancy Grp:
Total $154.34
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 th ules adopted by the Oregon Utility Notification er. ose rule .re set forth in OAR
952-001-0010 through OAR 952-001-0090. cv of the nil s or direct questions to OUNC by calling 503.23 1987 r :r r. 23;�
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Issued By: Permittee Signature: r
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
Cl O Tigard Received
+ 13125 SW all Blvd.,Tigard,OR 97223 P p°f DateB : i� " ik 'a-
g IA
Plan Review
II Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit k:
7n2?
Inspection Line: 503.639.4175 n n Ready Date/By: See Page 2 for
TIGARD
Internet: www.Ngard-0r.gov Notified/Method: S Supplemental Information
TYPE OF WORK PLAN REVIEW
El New construction Xf Addition/alteration/replacement Please check all that apply(submit F sets of plans wlitems checked):
IDService or feeder 400 amps or more 0 Building over three stories.
El 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.
I-and 2-family dwelling ❑ Commercial/industrial El Accessory building less to ground,or exceeds 14,000 ❑commercial- se agricultural
amps for all other installations. buildings.
❑Multi-family ❑ Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
w JOB SITE INFORMATION AND LOCATION'' ) _0 Emergency system. larger separately derived
Job#: V 7�, I Job site address: 71OU Sr✓)TA I(//�5. e r A•' (/A Addition of new motor load of system.
4/'�V /fit rY�100HP or more. ❑ •A,• ••E" •,1_2,,,••1.3„
City/State/ZIP: ❑Si:or more residential units. occupancy.
n' /n� 0/2 ❑Recreational vehicle parks.
T l�K ei 7 2.2.
� ❑Health-care facilities.
Suite Bldg./apt.#: Project name:
5 I.w a. ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more 600 volts nominal.
Cross street/directions to job site: 5“) 7'g A y Iacs, FEE SCHEDULEr
Description i Ore. I Each I Total 1 "
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.R.or portion 33.92 I
DESCRIPTION OF WORK n Limited energy,residential
/r IS ,/1 w ( / ��k C•r /1 c rN�Aie- G (with above sq.multi-family
75.00 2
�/�� f E/ ��C // `E.Ct)i S BMIJ c r Limitedenergy,ithab above
75.00 2
< J residential(with above sq.R.)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less / 100.70 /�142
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 59.36 I
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
❑ APLI>vANT = ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee£or branch circuits with
Business name: above service or feeder fee, 5.
each branch circuit 7.42 3Zie# 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'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Poem ILc,G 2 1 C L LC Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy Address: PI)I j 1 3 6 5 7 b panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: S 4 t.- s t( 173 9 Each additional inspection over allowable in any of the above
�r Additional inspection(1 hr min) 66.25/hr
Phone:(cog) 56( 96I I Fax:( ) 375 9 029 Investigation(1 hr min) 90.00/hr
Email: 1^' (^ �/y� s Industrial plant(I hr min) 78.18/hripki
,GI Cif` Gg . cVI'tA Inspections for which no flee is
CCB Lie.: en t 1 y Electrical Lie.:` b' 1 Sup Lie.: 3 Z7?-5 specifically listed(4 hr min) 90.00/hr
Suprv.Electrician signature,required: //.a(/S//�/ ELECTRICAL PERMIT FEES
P gn q t Subtotal: (3? go
Print name: A 0 6 LOB Date: 5/3/az ❑Plan Review Required(25o/n of permit fee):
VVV f State surcharge(12%of permit fee): 1 ehl
Authorized signature: , TOTAL PERMIT FEE: 15Ya3
- - This permit application expires its permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
19Building\PermitsuEl.C_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-4615T(I I/05/COM/WEB