Permit III CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Per
COMMUNITY ELC2022-00718
Date Issued: 10/25/2022
T l G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102AA05500
Jurisdiction: Tigard
Site address: 12215 SW MAIN ST
Project: Choi building Subdivision: KINGSTON Lot: 19
Project Description: Reconnecting electricity.
Contractor: Owner: CHOI, WOO Y&MAN JA
2323 NE 165TH DR
PORTLAND, OR 97230
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 10/25/2022 $67.84
Specifics: 1 ea 12%State Surcharge- 10/25/2022 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
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. regon law req -res yo, to ollow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through 0 952-001-0 may tai ov of the rules or direct auestions to OUNC by callino 503.232 107 .800.332.2344.
Issued By: Permittee Signature: ` 4
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 `
DateB : t r _ Permit#: •..-..� -GC) i •
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 14 B Phone: 503.718.2439 Date/B : Related Permit#:
Email: TigardBuildingPermits@Tigardor.gov Ready Date/By: .Avis: Er See Page 2 for
I I G A RI) 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):
❑Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition G Other:
where the available fault current ['Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ I-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use ag cultural
amps for all other installations. buildings.
El Multi-family ❑Master builder El Other: ['Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job Site address: ,-1 1 1 d ❑Addition of new motor load of system.
rl{ A,ti , 4-- 100HP or more. ❑"A","E","l-2","l-3"
City/State/ZIP: /�A �, ❑Six or more residential units. occupancy.
-�l t 'Q-O 0 17 91 2.7 3 ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: 4 Project name: ['Hazardous locations. 0 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 Obi. I Each 1 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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,,alteration,and/or relocation
Name: (( A ti , r.J 200 amps or less 100.70 2
r'/l S ��' 201 amps to 400 amps 133.56 2
Address: 2 3 Z3 N e l e,5 4t, Q ri
401 amps to 600 amps 200.34 2
City/State/ZIP: QO 4,1 A IJ h a2- '1 Z i 6601 amps to 1,000 amps 301.04 2
Phone:(.509 -5-(o, —261 �, 0 Over 1,000 amps or volts 552.26 2
l c� 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 snaps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
0 APPLICANT El CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
j each branch circuit 7.42 2
Contact name: -1 1 t v- E.(Q [� T��L�) t. -7 �O B.Fee for branch circuits without
�l 1 service or feeder fee,first
Address: f 3 6 710
C I act.- r),.�.ham, 19 ) t .. ) branch circuit 56.18 2
City/State/ZIP: ( 1 g'g_'9 r�0,J 97`�2 z_�Y�J Eachellanbranchcircuit 7.42 2
Phone:( ) ( / J VJ� 7 Miscellaneous(service or feeder not included)
1 r�(I)/- (-, 5 (, Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: A_ 1I U 0✓l O e" Y ill-{"c 0 . C::'tt.'t 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 ❑ 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:( ) 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 Lie.: Electrical Lic.: Suprv.Lie.: specifically listed(A hr min)
FJ.FCTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: . ,
I J TOTAL PERMIT FEE: ' 1 5 .1 E.
Thu permit application expires if a permit is not obtained within 180
Print name: T I 1 U F,g Q A nlbi7zLs 5 L L. Date: ie 7 C t., �.. days after it has been accepted as complete.
( L " Number of inspections allowed per permit.
1:13uildwgsPemrits\ELC PermitApp_ELR_ERE.doc Rev 10/26/2017 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
Fee for all residential systems combined: $75.00 Description
n oi an. I Each I TotalR
3' Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70
5.01 to 15 kva 133.56 2 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
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(Yz hr min)
COMMERCIAL WORK ONLY:. ELECTRICAL PERMIT FEES
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
El 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
L\Buildmg\Permits\ELC_PermnApp_ELR ERE.doe Rev 10/26/2017