Permit (3) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2022-00504
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/28/2022
Parcel: 1 S134AC01200
Jurisdiction: Tigard
Site address: 11410 SW IRONWOOD LOOP
Project: Thibodeaux Subdivision: ENGLEWOOD Lot: 40
Project Description: Obtaining permit to have electrical panel,previously installed,inspected.
Contractor: OWNER Owner: THIBODEAUX, COLLIN
11410 SW IRONWOOD LOOP
TIGARD, OR 97223
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 07/28/2022 $100.70
Specifics:
amps or less
1 ea 12%State Surcharge- 07/28/2022 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 requ'es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 throua 952-0 -0090. tiu may fi?i aCODV of the rules or direct auestions to OUNC by callina 503.(32.'1987 or 1.800.332.234/
Issued By: Permittee Signature: G
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
CI`, O Tigard and ReDate/B ceive: t od �,�/)
�L _Q V O L
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
■ Phone: 503.718.2439 Date/By: Related Permit#:
Email: TigardBuildingPemiits@Tigard-or.gov Ready Date/By: Juris: ® See Page 2 for
Inspection Line: 503.639.4175 Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Demo1ition ®Other:/NSPEC-T�d� �� Exp S7iA C, ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address: // /o S LJ /R_ox/-10-0 LGbP ❑Addition of new motor load of system.
`f 100HP or more. [I"A","E","]-2","1-3",
❑Six or more residential units. occupancy.
City/State/ZIP: / +P-D t I Z a3 ❑Health-care facilities. ❑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: Scc: /Rvn/�uao/J �P 5c Sr�f?m1G r.��ch FEE SCHEDULE
Description Qty. I Each Total
'/ New residential single-or multi-family dwelling unit.
Subdivision: Enf G L WU�,J Lot#: 11/0 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add]500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
with above sq.ft.) 75.00 2
Re)?&I � 1,VSPCCT/O^( OF LEC-7R/C 4,L Pf}AIEL Limited energy,multi-family
/A/5 F j L---ED Att G a 5 T 2-0/ � residential with above s .ft 75e 2 2
Renewable Energy
[:l See Pa e 2
PROPERTY OWNER 9[TENANT Services or feeders installation alteration and/or relocation
Name: e G 4-9-/At -7H- /Re e)C,+a X 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address: //'fro ScJ /iQvA/G�4'>i� LG`o�
401 amps to 600 amps 200.34 2
City/State/ZIP: 9,�/� ej +'� �/ X2.23 601 amps to 1,000 amps 301.04 2
Phone: S.f f3 - a7 Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: LTC o 1-1- /1V 77�:f 18� �/YJA /L , C0 114
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: Date: 401 amps to 599 amps 168.54 2
❑ APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration or extensionper panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7'42 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: ( ) 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: .40441A.1 /T JC O co At&,R Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energry
Address: panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) 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 Lic.: Suprv.Lic.: specifically listed Yz 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: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: o C L 1/47-191�d (� Date: tt Zit L days after it has been accepted as complete.
* Number of inspections allowed per permit.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
Description I Qty. I Each 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 to 25 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* >100 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:
❑ Other: Each additional inspection is 66.25/hr ]
charged at an hour] 1 hr min
Inspections for which no fee is 90.00/hr
spec scally listed '/z hr min
Subtotal(Enter
Fee for each commercialsystem: $75.00 Page I
* Number of inspections allowed per permit.t.
(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
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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