Permit (6) CITY OF TIGARD ELECTRICAL PERMIT
= COMMUNITY DEVELOPMENT Permit#: ELC2022-00537
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/10/2022Parcel: 2S111AA00300
Jurisdiction: Tigard
Site address: 14085 SW HALL BLVD
Project: L'ALLIER Subdivision: None Lot: None
Project Description: Adding(5)branch circuits for basement and master bath.
Contractor: OWNER Owner: L'ALLIER,JEFFREY
14085 SW HALL BLVD
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
Specifics: 5 crt Branch Circuits wo/Purchase 08/10/2022 $85.86
Service or Feeder
1 ea 12%State Surcharge- 08/10/2022 $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 folio the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 throuah OAR 01-00 .�ou v obtain a rules or direct auestions to OUNC by callino 503.232.1987 or 1.800.332.2344. �{
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.
Electrical Permit ApplicatioaR EC
City of Tigard iia? ) qL& !eeiv"ed ,:,E;/1. Date/
13125 SW Hall Blvd.,Tigard,OR 97223 -. ( Plan Review
Phone: 503.718.2439 CY OF 1C"AFib Date/By: Related Permit#:
Email: TigardBuildingPermits@Tigard pA`'y j P,1\/�&�}! }(: Ready Date/By: Juris: ® See Page 2 for
Inspection Line: 503.639.4175 htteilrt *h'v .igard-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):
❑ ❑Service or feeder 400 amps or more ❑Building over three stories.Demolition Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
1-and 2-familydwelling Commercial/industrial less to ground,or exceeds 14,000 ❑Commercial-use agricultural
g ❑ ❑ACC2SSOry budding amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOE .S]ITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
.lob#: Job site address: t _ / ❑Addition of new motor load of system.
V 100HP or more. ❑"A" "E" "1-2","1-3"
City/State/ZIP: (�
[I Six or more residential units. occupancy.
` ❑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: FEE SCHEDULE
Description . I Each I Total
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'1500 sq.ft.or portion 33.92 1
Limited energy,residential
with above sq.ft.)few75.00 2
1 I s� 111 r-, a n J Limited energy,multi-family
v,� CIA1A M + r residential with above sq.ft. 75.00 2
Renewable Ener
PROPERTY Ovi"—ft .Q TENANT ❑ See Page 2
Services or feeders installation alteration and/or relocation
Name: L 200 amps or less 100.70 2
Address: IqOIR5 S ` 201 amps to 400 amps 133.56 2
rk 401 amps to 600 amps 200.34 2
City/State/ZIP: s '1 601 amps to 1,000 amps 301.04 2
Phone:( ) o t' Over 1,000 amps or volts 1 552.26 2
/ Temporary services or feeders installation,alteration,and/or
Email: a ' b rnck relocation
Owner installation is instal on is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,l nt,or ploange,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
Cwr
Branch circuits—new,alteration ore tensionper 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
service or feeder fee,first
Address: branch circuit 56.18 �� ' 2
City/State/ZIP: Each add'l branch circuit Z4 7.42 T 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
COI+F ►CIOK Pump or irrigation circle 67.84 2
Business name: rY Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
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(I 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 '/�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 si a TOTAL PERMIT FEE:
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.
I:\Building\Permits _P itApp_ELR_ERE.doc Rev 10/26/2017 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 WORK ONLY- FEE SCHEDULE
Description I Qty. I Each To[al
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 1
charged at an hourly 1 hr min
Inspections for which no fee is 90.00/hr
s ificall listed '/2 hr min
COMMERCUL WORK I?11TT;
Fee for each commercials stem: $75.00 Subtotall(Enteron Page 1):
y * 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
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017
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.
ffp� Lill' ►Q�
PTam Permit Applicant
t r of Pe Applicant Date
Permit M
Address:
Issued by: Date:
This Copy for Permit Offices