Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2022-00483
Date Issued: 7/19/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S136DCO2600
Jurisdiction: Tigard
Site address: 7010 SW BAYLOR ST
Project: RIVERSIDE CARPENTRY Subdivision: ELNOLA HEIGHTS Lot: 1
Project Description: Reconnect only.
Contractor: Owner: RIVERSIDE CARPENTRY LLC
12042 SE SUNNYSIDE RD#584
CLACKAMAS, OR 97015
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 07/19/2022 $67.84
Specifics: 1 ea 12%State Surcharge- 07/19/2022 $8.14
Electrical
Type of Use: SF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
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 a c s or direct auestions to OUNC by callina 503 r 1.800.332.2344.
Issued Permittee Signature: Ale
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
City of Tigard Received 7, y�
Date/B i . ,,►p jpiomMi
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
■ Phone: 503.718.2439 Date/B : Related Permit#:
Email: TigardBuildingPermits@Tigard-or.gov Ready Date/By: Ju ® See Page 2 for
f I G A 1(I) 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):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 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.
❑ 1-and 2-family dwelling ❑Commercial/industrial El Accessory building
less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings,
❑Multi-family 0 Master builder er: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: io ,.).3 ❑Addition of new motor load of system.
isQ. /tQf— l0OHP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: �1.r J 0 t 9 7-2 2 3 0 Six or more residential units. occupancy.
0✓ ❑Health-care facilities. Recreational vehicle parks.
SUite/bldg./apt.#: Project name: �,I ID Hazardous locations. 0 Supply voltage for more than
�1 t/L�t "t Y� ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description 1 Qty. I Each I Total I *
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 75.00 2
/`- e..„/ e G� (witht ne gy,bove q. t)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
,���,,,���� Renewable Energy 0 See Page 2
a—rxurERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: � 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address:
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) 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 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
0 APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
L A.Fee for branch circuits with
Business name: R 1vQ,('�i lG- Ci,.f Q.a.Js-e'l L... L above service or feeder fee, 7.42 2
each branch circuit
Contact name: A t- ;ma y(,,-1„1+ ,44- B.Fee for branch circuits without
Address: 12 01.1 z 5 C 5�(v) Sy'J t_ } �q service or feeder fee,first
Y P'fJ J O branch circuit 56.18 2
City/State/ZIP: C(a cl-co.,c.,.,s p Q. q'?01 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(9I b ) UZ- 93 II Each manufactured or modular 67.84 2
�1 2 ( (...04(171 dwelling,service and/or feeder
Email:
P Q4 `tVt- iJ c fi(().n Y i c r Reconnect only / 67.84 2
CONTRACTOR Pump or irrigation circle ( 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. 0 See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP:
Additional inspection(1 hr min) 66.25/hr
Phone:( ) 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('/z 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: A t,L� I(�„,`/,f,.. Date: `�9 14 /ZOZ Z 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:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qtp. I Each I Dotal
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
D Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ H• eating, 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 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
s.ecificall listed %hr mine
�
tirr
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
3 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
ri A• udio and Stereo Systems
❑ B• oiler 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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