Permit N. CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2022-00267
Date Issued: 4/26/2022
TIG.ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103AC05100
Jurisdiction: Tigard
Site address: 12775 SW 113TH PL
Project: CANNON Subdivision: HUMBOLDT CREEK ESTATES Lot: 2
Project Description: Replacing(1)garage panel, installing(1)sub panel outside house,and installing (1)branch circuit for a new
condenser unit.
Contractor: OWNER Owner: CANNON, WILLIAM & MARY
12775 SW 113TH PL
TIGARD, OR 97223
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Services or Feeders-200 04/26/2022 $201.40
Specifics: amps or less
1 crt Branch Circuits w/Purchase 04/26/2022 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 04/26/2022 $25.06
Type of Const: Electrical
Occupancy Grp:
Total $233.88
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 throuahhO OAR
R9952-001-0090. You may obtain a rules or direct questions to OUNC by callino 503.232.1987 800.332.2344.
Issued By: cGT Permittee Signature:
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 orrice: t sl.:ONl,l
City of Tigard ` r Received
114 II 13125 SW Hall Blvd.,Tigard,OR e• ,G 1j/ ® DateB : it, ,�(�� F �„ r���
g v "// Plan Review Related Permit#: _>e Phone: 503.718.2439 Fax: 503.5°8. Date/B : i> C.y ,A A.
Inspection Line: 503.639.4175 77 Ready Date/By: Juris: BI See Page 'for
TIC ARD APR 16 r 0"
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF Wliffle i PLAN REVIEW
❑New construction ®Addition,alteration/replacetnent Please check all that apply(submit 2 sets of plans w items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other:
where the available fault current ❑Marinas and boatyards.
`) '�Ili"`Ii` CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
Multi-familyMaster builder Other: amps for all other installations. buildings.
❑ ❑ ❑ ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE LNFORMATION AND LOCATION 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address:
12775 SW 113th PI 100HP or more. ❑"A","E","1-z»,"1-3",
City/State/ZIP: Tigard/OR/97223 R/97223 ❑Six or more residential units. occupancy.
g ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: I'.P"EE C:`l ,1 'i':
Description I Qty. I Each l Total r
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#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Replace main 200A panel in garage. Add new Sub-Panel Limited energy,multi-family
outside house. Add circuit for AC Condenser unit. residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
® PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: William Cannon 200ampsorless 2 100.70 201.40 2
Address: 1 2775 SW 113th PI 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Tigard/OR/97223 601 amps to 1,000 amps 301.04 2
Phone:(503) 360-3338 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: billtronix@gmail.com 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 signatur-: Date: 401 amps to 599 amps 168.54 2
of ,; t Branch circuits—new,alteration,or extension,per panel
AliniantaaCEMA.Fee for branch circuits with
Business name: QS ,, rt_ above service or feeder fee, 1 7 42 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address:
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: ftti,e- Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: panel,alteration,or extension. g
Each additional inspection over allowable in any of the above
City/State/ZIP:
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 is 90.00/hr
CCB Lic.: Electrical Lie.: Suprv.Lie.: specifically listed('/hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 208.82
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 25.06
TOTAL PERMIT FEE: 233.88
Authorized signature:
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.
t:Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(I1/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WOR ONLY:
Description I Qty. 1 Each 7 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
❑ A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ B• urglar 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
with OAR 918-309-0040) 552.26 2
❑ 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
charged at an hourly(1 hr min) 66.25/hr 1
Inspections for which no fee is 90.00/hr
specifically listed('V2 hr min)
ELECTRICA . PE> IT flE 4 1 ,..' '[E
'WQ�'ONLY:'.' S fA Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections 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
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ 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
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
Property Owner Statement
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))
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 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.
or
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.
CfrLAAL)A.
Print Name of Permit Applicant
D 4.1/2 6/..lo 2 2_ _
Signature of Permit Applicant Date
Permit#: _}=L-L 9ZIA3 ' '
Address: /j 14' +•;r
C4e. 4 12.3 ,
Issued by: Date: //A/2l C-I
This Copy for Permit Offices