Permit CITY OF TIGARD ELECTRICAL PERMIT
11,1
COMMUNITY DEVELOPMENT Permit#: ELC2022-00287
Date Issued: 5/4/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S125DB04800
Jurisdiction: Tigard
Site address: 7185 SW SHADY CT
Project: Lawrence Subdivision: SHADY DELL NO.2 Lot: 22
Project Description: Electrical for 50 sq.ft.addition in back of the house:(5)branch circuits.
Contractor: OWNER Owner: LAWRENCE, BRIAN J REVOCABLE TRUST
7185 SW SHADY CT
PORTLAND, OR 97223
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo/Purchase 05/04/2022 $85.86
Specifics:
Service or Feeder
1 ea 12%State Surcharge- 05/04/2022 $10.30
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
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. Th rules are set forth in OAR
952-001-0010 throuah OAR 952-001-0090. You m ' a coov o ules or direct questions to OUNC by callino 503.232.1987 or .2344.
Issued By: 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.
•
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), C neeRIE I1�Er'`tL�
submit this statement. This statement will be filed with the permit. fl
---- — ---------- ---------- ---- ---- — - ---------------
Please check the appropriate box: MAY 4 2022
CITY OF TIGARD
structure and myBUILDING DIVISIONI own, reside in, or will reside in the completed
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
X 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.
Brian Lawrence
Print Name of Permit Applicant
5/2/2022
Signature of Permit Applicant Date
Permit#:
Address: -2 S 32,/ Lr6i-t-v I
E VII ,Ih,YfrI r
Issued by: /5,_2- Date:
This Copy for Permit Offices
,
Information Notice to Owners About
• ` Construction Responsibilities
v4;:v�_i (ORS 701.325 (3))
Homeowners acting as their own general contractors to construct a new home
or make a substantial improvement to an existing structure,can prevent many problems
by being aware of the following responsibilities:
• Homeowners who use labor provided by workers not licensed by the Construction Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
• Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages
at the time employees are paid. You will be liable for the tax payments even if you don't actually
withhold the tax from your employees. For more information, call the Department of Revenue at
503-378-4988.
• Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information, call the Oregon Employment
Department at 503-947-1488.
• Oregon's Business Identification Number(BIN): is a combined number for both Oregon
Withholding and Unemployment Insurance Tax. To file for a BIN, go online to the Oregon Business
Registry. For questions, call 503-945-8091.
• Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain
Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs
if one of your workers is injured on the job. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 800-452-0288.
• Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from
employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax.
For a Federal EIN number, go online to www.irs.gov.
Other Responsibilities of Homeowners:
• Code Compliance: As the permit holder for a construction project, the homeowner is responsible
for notifying building officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
• Property Damage and Liability Insurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensation Insurance.
• Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough-in and finish trades.
CONSTRUCTION CONTRACTORS BOARD
PO Box 14140,Salem,OR 97309-5052
Telephone:503-378-4621—Fax: 503-373-2007
Website Address:www.oregon.govic._ck
f/property_owner adopted 9-2016 This Copy for Permit
Ejectrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received Permit K
y 13125 SW Hall Blvd.,Tigard,OR 97223 �� � Review " �� �2 � La
_ Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit ��, �
inspection Line: 503.639.4175 202 r Ready Date/By: kris: �y��/•
T1(.ARD S plemene e.for
Internet. www.tigard or.gov MAY *otifiediMerhud
Supplemental information
TYPE OF WORK :. TY OF TtC.ARU
PLAN REVIEW
0 New constniction kli Additionialteration/IXOTSITIPNC DIVISION Please check all that apply(submit 2 sets of plans wlitems checked):
0 Demolition 0 Other: ❑Service or feeder 400 amps or more 0 Building over three stones.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
�-t t-and 2-familydwelling Commercial/industrial less to ground,or exceeds 14,OO1J 0 Commercial use agricultural
J4i b ❑ El building 1 amps for all other installations buildings.
❑Multi-family 0 Master builder
0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job it: Job site address:
7185 SW Shady Ct. ❑Addition of new motor load of system.
❑iOOHP or more. "A" "E","1-2""1-3"
City/State/ZIP: Portland, OR 97223 ❑Six or more residential units. R occupancy.
❑Health-care facilities. ❑ ecreational vehicle parks.
Suitebldg.iapt.#: Project name: Add iton Lawrence 0 Hazardous locations. 0 Supply voltage for more than
El Service or feeder 600 snips or more. 600 volts nominal
Cross street/directions to job site: I FEE SCHEDULE
-- _- DctcripBon Qtp, l 1:ach 'fatal *
New residential single-or multifamily dwelling unit.
Subdivision: Tax ID:R231305 Lot#: includes attached garage.
O 1,000 sq.11.or less 168.54 4
Tax map/parcel1 S 1 1 25BO4000 Ea.add'1500sq.ft.or portion 33.92 1
DESCRIPTION OF WORK {
Limited energy,residential 75.00 2
Adding 50 sq ft and repositioning the kitchen (with abovesq.ft.)
Limited energy,multi-family 75
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
gi PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
t - _
Name: Brian Lawrence 200 amps or less _ i00.70 2
7185 SW Shady Ct 201 amps to 400 amps 133.56 2
Address:
401 amps to 600 amps 200.34 2
City/State/ZIP: Portland OR 97223 601 amps to 1.000 amps 301.04 2
Phone:( )5033098868 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: briar Iawrence _yahoo.com relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 1 I 59.36 i
intended for sale,le se,rent,o�r_gchange,according to ORS 447,449,62fj_and/�12 201 amps to 400 amps i 125.08 2
Owner signature: T Date: U2 401 amps to 599 amps 1 168.54 _ 2
APPLICANT circuits-new,alteration,or extension,per panel
❑ CONTACT PERSON A.Fee for branch circuits with
Business name: Ryone LLB. _ _ above service or feeder fee, 7.42 2
each branch circuit
Contact name: Raul Onescu + B.Fee for branch circuits without
service or feeder fee,first
Address: 5321 Lakeview Blvd. branchcircuit 56.18 �, 2
City/State/ZIP: Lake Oswego OR 97035 __----_-__-- a� ieancus� � 2 ,toy 2E adto =erve or feederrat included)
Phone:( ) 9713229416 I Fax: :( ) Each manufactured or modular
dwelling,service and or feeder G r.84 2
Email: raulone28@gmail.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 4, r- Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy Address: panel,alteration.or extension- El See Page 2 2
CitylState/ZiP: Each additional inspection over allowable in any of the above
Additional inspection(i hr min) 66.25.hr
Phone:( ) Fax:( ) investigation(l hr min) 90.001 hr
Email: Industrial plant(1 hr min) 78.i 8.!hr
Inspections for which no fee is
CCB Lie.: I Electrical Lic.: Suprv.Lie.: specifically listed(','hr min) 90.00 hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
Subtotal: .-
Print name: Date: , 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): j tl , 30
Authorized signature: //I TOTAL PERMIT FEE: , eiG,,t 0
This permit application expires if a permit is not obtained within 180
Print name: Raul Onei„ ! Date:[�/'29/2022 I days after it has been accepted as complete.
" Number of inspections allowed per permit.
1:•.aui!dingtpermiiitE•t,C.pcnnitApp ELR_ERE..Ws An 06'17;2015 4404615T(11iO5JCOMr'WEn
Electrical Permit Application—City of Tigard
'. Page 2—Supplemental information
it
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 Description Qh. Each T—Total 1 "
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less l00.70 ' 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva
200.34
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
[1] Garage Door Opener* 50.0!to loo kva 552.26 2
>100 kva(fee in accordance 55226 2
with OAR 918-309-00401
❑ Heating, Ventilation and Air Conditioning
System* solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
EVacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25 hr
1 1 charged at an hourly(1 lu min)
Inspections for which no fee is
specifically listed t'2 hr min) + 40.00;hr
COMMERCIAL WORK ONLY: j ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page I>:
(SEE OAR 918-309-0000) " Number of itnpecuoas allowed per permit
Check Type of Work Involved:
❑ Audio and Stereo Systems
E Boiler Controls
E Clock Systems
[l D• ata Telecommunication Installation
❑ Fire Alarm Installation
(� H• VAC
❑ Instrumentation
Intercom and Paging Systems
E Landscape Irrigation Control*
E Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
E Protective Signaling
f] Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I`�BuitdingSPermiis\ELC_PermtApp E1.R_ERE.doc Rev 06/17/2015