Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT
Ill
Permit#: ELC2022-00798
Date Issued: 12/1/2022
TICAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 2S1026C00800
Jurisdiction: Tigard
Site address: 10095 SW WALNUT ST
Project: COLLING Subdivision:RTH TIGARDVILLE ADDITION,AMENC Lot: 5
Project Description: Meter base replacement.
Contractor: HARBOR NORTHWEST ELECTRIC LLC Owner: COLLING TIGARD PROPERTIES LLC
1404 NE 17TH AVE BY COLLING, CHARLES W
BATTLE GROUND, WA 98604 13835 SW HALL BLVD
TIGARD, OR 97223
PHONE: 503-358-8723 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 12/01/2022 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 12/01/2022 $12.08
Type of Use: COM 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 requires you to follow the rules adopted by the Oregon Utility Notificatiohl Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You of the rules or direct questions to OUNC by callina 503.y37.19,7 or 1.800�322.2341.
Issued By: -.�z,✓ — 1 Permittee Signature: // I
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'
o Tigard Received y Pe m t ti:
'� City g Date/By: I)- 'li;."._. j5 1 4=�i( ?' .409_`Ci-, /xx'1 rp
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review i
Phone: 503.718.2439 Fax: 503 598CEr4 ED Date/By:: Related Permit a:
Inspection Line: 503.639.4175 ' * Ready Date/By: Juris: RI See Page 2 for
1 Il'A1I) Internet: www.tigard-or.gov Notified/Method: ; Supplemental Information
'iCo
TYPE WORK"-, PLAN REVIEW
❑New construction ❑Addition/al teratiOp/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.
❑Demolition ❑Other: .l '' 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 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ['Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: /0 O o)c !'� /,J a/� T It0HP or more.
City/State/ZIP: y� (� -7 ❑Six or more residential units. occupancy.
/ •
/A f a/�tI_ / c/ t. 1-3 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: 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: U rA r A,,...." & b /N ,i 1 FEE SCHEDULE
Description I Qty. I Each I Total I '
New residential single-or multi-family dwelling unit. •
Subdivision: Lot 4: Includes attached garage.
Tax map/parcel 4: 1,000 sq.fl.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
`` - (with above sq.ft.) 75.00 2
*T t7 J rr1/(. ts..---er!� G�'�' ) ,r v ti Limited energy,multi-family
JF.
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
- PROPERLY OWNER 0 TENANT
d
Q / Services or feeders installation,alteration,and/or relocation
Name: r/n O/it. (b i/ I Yt' "S 200 amps or less j 100.70 70 2
Address: - / ?.0 3 r / �/ry// g/U 201 amps to 400 amps 133.56 2
/ t 401 amps to 600 amps 200.34 2
City/State/ZIP: -6h 4// ! b 2 5-1 Z -t. 'J 601 amps to 1,000 amps 301.04 2
Phone:(Sd3 ) l 6 �6/Z ce Fax:( ) Over 1,000 amps or volts 552.26 2
Email: �' ? p r -� Temporary services or feeders installation,alteration,and/or
Sn of(13Z ® eem (s S C relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
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 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: 11 v L ,,3 p"YL f _ B.Fee for branch circuits without
_ �+ service or feeder fee,first
Address: l0 S Y Z. 5L' I I '"Mt" o-Ica i, branch circuit 56.18 2
City/State/ZIP: fi S 0, b 2 v l 7 Z,13 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) 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: a out l,,. �r ES+ 64,.v.iG Sign or outline lighting 67.84 2
iar, Signal circuit(s)or limited-energy Address: 23401 OOI i. t Coop 124 panel,alteration,or extension. ❑ See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP:
8aii0 �V I w44 ' qs(a )q
Additional inspection(1 hr min) 66.25/hr
Phone:(5Q3) . 5C ,8723 Fax:( ) Investigation(1 hr min) 90.00/hr
�-.✓ Industrial plant(1 hr min) 78.18/hr
Email:
r 511Pi a i I •LLIVIN Inspections for which no fee is
7/I specifically listed('V hr min) 90.00/hr
CCB Lic.: �(� i9b Electrical Lic. C ��uprv.Lic.: rs
ELECTRICAL PERMIT FEES
Suprv.Electrician signs hie)
' wired: ` . i/t/d) Subtotal:
Print name: jai,-,1 l r A_ Date: 'i_Di i.z2 El Plan Review Required(25%of permit fee):
JState surcharge(12%ofpermitfee); pi,)if
Authorized signature: 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.
1:1Buildme\Permits\ELC_PernitApp_ELR_EREdoc Rev 06/17/2015 4404615T(I1/05/COMJWEB
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 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 to25 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 he min)
Inspections for which no fee is 90 00/hr
specifically listed(%,hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I):
Fee for each commercial system: $75.00 •
• Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ A• udio and Stereo Systems
❑ Boiler Controls
❑ C• lock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm installation
❑ H• VAC
❑ 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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