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Permit n CITY OF TIGARD ELECTRICAL PERMIT `�1 = COMMUNITY DEVELOPMENT Permit#: ELC2022-00331 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 5/25/2022 Parcel: 2S103AA01400 Jurisdiction: Tigard Site address: 10825 SW ERROL ST Project: Dove Subdivision: ECHO HEIGHTS Lot: 3 Project Description: Kitchen, Living room and back addition rewire. Contractor: OWNER Owner: DOVE, JOHN ROBERT 10825 SW ERROL ST TIGARD, OR 97223 PHONE: PHONE: FAX: FEES Quantity Description Date Amount 14 crt Branch Circuits wo/Purchase 05/24/2022 $152.64 Specifics: Service or Feeder 1 ea 12%State Surcharge- 05/24/2022 $18.32 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $170.96 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 coos of the rules or direct Questions to OUNC by callina 503.232.1987 or 1.800.332.2344 Issued By: Edga rotes Ma Ld o�ad o Permittee Signature: Se--e-'U Ysta�t Gi Ova 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 RECEIVE , Received ��/ FOR OFFICE USE ONLY City of Tigard Date/B :OS�-( Permit#: EL�ZI�ZZ-00�3 I 13125 SW Hall Blvd.,Tigard,OR 97223 MAY 2 3 2022 Plan Review _ Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#: Inspection Line: 503.639.4175 Ready Date/By: .tuns: ® See Page 2 for TIGARD Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information BIM DING DIVISION TYPE OF WORK PLAN REVIEW ❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 400 amps or more 0 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 0 Floating buildings. © 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural ngs. ❑ Multi-family 0 Master builder 0 Other: ampsireform all other installations. Inbustdlatio 0 Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived AddJob#:Dove Job site address: 10825 SW Errol St ❑100H P or more ion of new motor load of system. 00H . ❑"A","E","1-2","1-3", gCity/State/ZIP: Tigard,OR 97223 0 Six or more residential units. occupancy. ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: Dove 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: SW Fonner St FEE SCHEDULE Description I Qty. I Each I Total 1 New residential single-or multi-family dwelling unit. Subdivision: Echo Heights Lot#: 3 Includes attached garage. Tax map/parcel#: 2S 103AA01 400 1,000 sq.ft.or less 168.54 4 Ea.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 2 Kitchen,living room,back addition rewire. Limited energy,multi-family residential(with above sq.ft.) 75.00 2 Renewable Energy 0 See Page 2 ® PROPERTY OWNER El TENANT Services or feeders installation,alteration,and/or relocation Name: John Dove 200 amps or less 100.70 2 Address: 10825 Sw Errol St 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:( 631 ) 742-8680 Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: dovehousehold@outlook.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 signature: �JTi �9(� Date: 12/15/21 401 amps to 599 amps 168.54 2 ® AP (CANT ® CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: N/A above service or feeder fee, 7.42 2 each branch circuit Contact name: John Dove B.Fee for branch circuits without service or feeder fee,first 1 Address: 108245 SW Errol St branch circuit 56.18 2 City/State/ZIP: Tigard,OR 97223 Each add'I branch circuit 13 7.42 2 Miscellaneous(service or feeder not included) Phone:( 631 )742-8680 Fax: :( ) Each manufactured or modular 67.84 2 Email: dovehousehold@outlook.com dwelling,service and/or feeder Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67.84 2 Address: Signal circuit(s)or limited-energy 0 See Page 2 2 panel,alteration,or extension. City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr Industrial plant(1 hr min) 78.18/hr Email: Inspections for which no fee is 90.00/hr CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed(%hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: yi Z7g� TOTAL PERMIT FEE: AJ This permit application expires if a permit is not obtained within 180 Print name: John Dove Date: 12/15/21 days after it has been accepted as complete. ' Number of inspections allowed per permit. 1\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/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 I * 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 n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 111 G• ara e Door O ener* 50.01 to 100 kva 552.26 2 g p >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 66.25/hr charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(1/2 hr min) ELECTRICAL PERMIT FEES COMMERCIAL WORK ONLY: 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 n Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation n H• VAC n Instrumentation ❑ Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical n N• urse Calls ❑ O• utdoor 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_Permi1App_ELR_ERE.doc Rev 06/17/2015 RECEIVED Property Owner Statement MAY 2 3 2022 Regarding Construction Responsibilities CITY OFTIGARD Oregon Law requires residential construction permit applicants who are not licensed wi lllI@ING DIVISION 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 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. John Dove Print Name of Permit Applicant � �d 12/15/21 Si ature of Permit Applicant Date Permit#: 0 F Address: H C'�` � Issued by: Date: This Copy for Permit Offices Information Notice to Owners About Hl � J= Construction Responsibilities (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.gov/ccb f/property_owner adopted 9-2016 This Copy for Permit