Permit 11111
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2022-00741
TIGAR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/2/2022
Parcel: 2S103DD02200
Jurisdiction: Tigard
Site address: 10940 SW GARDEN PARK PL A
Project: Vallely Subdivision: GAARDE PARK Lot: 6
Project Description: (1)branch circuit to heat pump
Contractor: OWNER Owner: VALLELY, CODY&OLIVIA
10940 SW GARDEN PARK PL
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 11/02/2022 $56.18
Specifics:
Service or Feeder
1 ea 12%State Surcharge- 11/02/2022 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Tota I $62.92
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 obtaina coo I me les or direct Questions to OUNC by calling 503.232.1987 or 1. 00 2
Issued By: ter/ /�L%yL 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 Application FOR OFFICE USE ONLY
City of Tigard I�j l iMili
;� ■ 13125 SW Hall Blvd.,Tigard,OR 97223 E 0 F! Y E 'i'lan Review
g Phone: 503.718.2439 Fax: 503.598 19 0 /pate : Related Permit it 8:
Inspection Line: 503.639.4175 Ready Date/By: Juris laSee Pate 2 for
1 15.':11.I) Internet- i www.tigard-or.gov 0'! f, ?9(l O n Notified/Method. — Yh Supplemental Information
TYPE OF WORK y,,,; PLAN REVIEW
0 New construction ❑Addition/alteration/replacement ,i 0(v Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more ❑Building over three stories
D 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.
El1-and 2-family dwelhn less to ground,or exceeds 14,000 0 Commercial-use agricultural
g ❑Commercial/industrial ❑Accessory building
❑ 0 Multi-family0 Master builderOther: ampsirefor all other installations. Ibuildings.atio
❑FDe pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
.lob#: I Job site address: it 07 Li 0 Si� _f , Q ' 0 Addition of new motor load of system.
f' rr �"+"�Ai.J Y�i �µte IOOHP or more. ❑"A" «E" "1-2" "1-3"
occu
City/State/ZIP: n-1w r,� -C
o _ q 3 D Six or more resident al un s. 1c
n
{� 'j 2 z ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: 4- I Project name: \ cs. 1\.e.-1" 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nmmnal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I •
New residential single-or multi-family dwelling snit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
G) b � i 2 re-M 1 / (with above y m s [l.)
T/ 1 �W i't�a-� Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
JPROYERTY.OWNER ,, _. 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: Cis a4.7 _U,k. I(.4.) 200 amps or less 100.70 2
Address: l 01 Lt U C> G. (-c'k R0 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: j f, of re\ O )Z._ 1 i t Z 3 601 am
ps to 1,000 amps 301.04 2
Phone:( O) 5.tJ _I i7 O Z(,) Fax:( ) Over 1,000 amps or volts 1 552.26 2
I Temporary services or feeders installation,alteration,and/or
Email: 1 r."l t� S �t'i A, L .� relocation
Owner installation:This installati n is emgmade on property that I own which is not 200 amps or less 59.36 l
intended for sale,lease t,or hang riling to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: C , r? � Date: 1 ( -Z'-2 401 amps to 599 amps 168.54 2
0'APPL CANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: /,, above service or feeder fee,
'�' � 3 G'mac"� each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 1 56.18 2
branch circuit
City/State/ZIP: Each add')branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax::( ) 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: C'i ,'._'p - Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 0 See Page 2 2
panel,alteration,or extension.
City/Slate/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) I Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: I Electrical Lic.: I Suprv.Lie.: specifically listed(V2 hr min)
ELECTRICAL 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: TOTAL PERMIT FEE: /_ 1 c4.)
This permit application expires if a permit is not obtained within180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
r.aauddmglPern,i tELC_PerntitApp_ELR_ERE.doe 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 Qtr. I Each I Total I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
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)
0 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('/z hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00
Subtotal(Enter on Page 1):
a 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
❑ I-IVAC
❑ 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.l Building\PernilslELC PernaApp_ELR ERE.doc Rev 06/17/2015
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.
Ok' ,�
Print Name 6f Permit Applicant
�� - 2- 22--
Signet e of Permi plicant Date
Permit#: •>,r,
Address: 1 94/0 2Q 1e(A) �.wr
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'RR
Issued by: {). 1 Date: 11-1a1��
This Copy for Permit Offices