Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2022-00813
Date Issued: 12/21/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135CA11500
Jurisdiction: Tigard
Site address: 11481 SW 96TH AVE
Project: CASS Subdivision: EVERETT TERRACE Lot: 14
Project Description: (1)branch circuit for vehicle charger.
Contractor: JAKES ELECTRICAL CONTRACTING LLC Owner: BLANCAS, MATTHEW STEVEN
5804 NE EVERETT ST CASS, JOSHUA ERIC
PORTLAND, OR 97213 11481 SW 96TH AVE
TIGARD, OR 97223
PHONE: 503-740-3164 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 12/12/2022 $56.18
Specifics:
Service or Feeder
1 ea 12%State Surcharge- 12/12/2022 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $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
�9,52-0001_-0090. You.mayte obtain a coov of the rules or direct auestions to OUNC by calling 503.232.1987 or 1.800-.332.2344.
Issued By: " Permittee Signature: C 80J/ .
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
• 13125 SW Hall Blvd.,Tigard,OR Date Rev a/fain" '-mtit#: E J c '�1-_00cy 3
Plan Review ,1 ,f '' -C/`� P 9
10 Phone: 503.718.2439 Fax: 503.598. Date/By: /V I� Related Permit#:
Inspection Line: 503.639.4175 Readyy H See Page 2 for
1 I G A R I) EEC
DateB Jvris.
Internet: vvww.tigatd-or.gov 1,d C ,1 2, 2022 Notified/Method:py1 . % .- >C• Supplemental Information
TYPE OF 1vOF110 . 6 ( PLAN REVIEW
❑New construction XAddltion/a e-r Please check all that apply(submit 2 sets of plans w/items checked):
it. I y 40-',. ❑Service or feeder 400 amps or moreBuildin over three stories.
❑Demolition ❑Other: where the available fault current 0 8
0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION
exceeds 10,000 amps at 150 volts or 0 Floating buildings.
X1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: 7ob site address: q SW _` Aste�p 0 Addition of new motor load of system
I `• .- I00HP or more. ❑"A","E',"I-2""1-3"
City/State/ZIP: l;g�- pi�' ci"t aa'3 Q Six or more residential units. occupancy.
f `' ❑health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: E'V Cnatr iz,Ne 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: G(eyrkp�rft Ra , FEE SCHEDULE
J Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: R a l, 6 p/a 1,000 sq.ft.or less 168.54 4
jam'Y Ea.add'1500 sq.ft.or portion 33.92 I
DESC TION OF WORK Limited energy,residential
E V c fietr (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
PROPERTY OWNER I 0 TENANT Renewable Energy ID See Page 2
� ` Services or feeders installation,alteration,and/or relocation
Name: :)4S1t5A CQ 3 J.
I1 200 amps or less 100.70 2
Address: 11 9�1 S W _l 6 L, j 201 amps to 400 amps 133.56 2
n'�1 401 amps to 600 amps 200.34 2
City/State/ZIP: ( tC et t 0 _I,Oa3 601 amps to 1,000 amps 301.04 2
Phone:(547)VI 5"7e\ 8 Fax:(.__.)� Over 1,000 amps or volts 552.26 2
Email: 1�� Temporary services or feeders installation,alteration,and/or
))uS act— q� Y,1 e. ou}'aak.CA►I-k relocation
wnerinstallation:This installation is bei made on p rty that I own which is not 200 amps or less 59.36 1
i tended r le,leas en or exchan ,acc din RS ,449,670, 201 amps to 400 amps 125.08 2
O signatur . 7 Z nips to 599 amps 168.54 2
❑ APPLICANT I CONTACT PERSON Branch circuits-new,alteration,or extension, i.er panel
A.Fee for branch circuits with
Business name:TS,ke; Fie � f` C NI �h�YQ
( , c (XI"
above service or feeder lee, 7.42 2
Contact name:
each branch circuit
xy` 1`etl� QS'�Yh�r B.Fee for branch circuits without t-�f pf�
'O Address: (a3 3 S k 3 9,t-� Ave.. ranch i feeder fee,first 56.18 Jb- p
V� - branch circuit 2
City/State/ZIP:coy-.,a na Q� 9 as` Each add'l branch circuit i 7.42 2
\
Phone:( 3) Miscellaneous(service or feeder not included)
a 3 _ Fax; ;( ) Each manufactured or modular
dwelling,service and/or feeder Email: ' gU 67.84 2
'
�01 r .elei.A-rlLA, (i:Thi- ' k.1vje�Inall . (,a
IAA Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 5 I,'Je Li r;c011 f Ad- -q f .+1 v Sign or outline lighting 67.R4 2
V Address: �+ �`y v VY Signal circuit(s)or limited-energy
t"( l �jQ5yQ. J"4 panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Pork�An d 0 32 CI 1,21Each additional inspection over allowable in any of the above
( Additional inspection(I hr min) 66.25/hr
Phone:( ¢ ) `?Y —7) 16 Fax:( �--- Investigation(I hr min) 90.00./hr
r plant(I ) 78.18/hr
Email: 1.� Industrialhr min
J� (~a �'�V1 Yt LTV ����Lt l»Q@ gfvl(�1t . (A!h inspections for which no fee is
,f ✓ .A.k.: /I specifically listed(/hr min) �00/hr
CCB Lic.: b� Electrical Lie.:C '11 9ylatr fly
Ai ELECTRICAL PERMIT FEES
4::.
. Suprv.Electrician signature,required: Subtotal: A 56,18
PIillt name: I per;; ❑Plan Review Required(25%of permit fig):
State surcharge(12%of permit fee): it C,—)A-1
Authorized signature: TOTAL PERMIT FEE: A c a 1
This perms application expires if a permit is not obtained within ISO
Print name: Date: days after it has been accepted as complete.
// -� a Number of inspections allowed per permit.
1:YBuildinglPermits1ELC_PermitApp ELRERE.doc Rev 06/17/2015 4 d4615T(1 I/05/COMEYEa