Permit (32) CITY OF TIGARD ELECTRICAL PERMIT
a • COMMUNITY DEVELOPMENT
Permit#: ELC2023-00517
T(CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/29/2023
Parcel: 2 S 107AA01200
Jurisdiction: Tigard
Site address: 14357 SW 168TH AVE
Project: McSwenney Subdivision: ROSHAK RIDGE Lot: 12
Project Description: (1)branch circuit for bedroom remodel.
Contractor: MOUNTAINWOOD HOMES INC Owner: MCSWEENEY, RICHARD F
11675 SW 66TH AVE DIMASTRODONATO, VALERIA
PORTLAND,OR 97223 14357 SW 168TH AVE
TIGARD,OR 97224
PHONE: 503-746-7338 PHONE:
FAX:
FEES
Quantity Description Date Amount
Specifics: 1 crt Branch Circuits wo/Purchase 08/29/2023 $56.18
Service or Feeder
Type of Use: SF 1 ea 12%State Surcharge- 08/29/2023 $6.74
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 lane. This permit will expire if work is not started within 180 days of issuance, . if ork is suspended for more the
180 days. ATTENTION: Oregon I squires you to follow the rules adopted by the Oregon Utility Notification Center. Ise rules are set forth in OAR
952-001-0010 throu -OAR 952- -0090. You .•obtain a v of the rules or direct questions to OUNC by ca'lk.°503 2.1987'.8r r 32.2344.
Issued By: Permittee Signature: r-:,ry
OWNER INSTALLATION ONLY 4F�
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 503.638.4175 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 ApplicationR EC E IVE W roR OFFICE USE ONLY
,� City of Tigard AUGReceived 1 .
• 13125 SW Hall Blvd.,Tigard,OR 97223
U 2 9 2023 D003 : t INN UT • t il' Permit#: L C R)Z U I i'OV
Plan Review •
DateB
I Phone; 503.718.2439 Fax: 503.598.1960 Related •
Pe m t#:
I I G A I:[I Inspection Line: 503.639.4175 CITY OF TIGARD Ready Date/BY: kris: 63 See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ❑"Addition/alteration/re lacement Please check ail that apply
p pp y(submit 2 sets of plans wiitenrs checked):
0 Service or feeder 400 amps or more 0 Building over three stories_
El Demolition 0 Other:
CATEGORY OF CONSTRUCTION. where the available fault current 0 Marinas and boatyards.
exceeds 10,000 amps at 150 volts or 0 Floating buildings.
lam'1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address: I1'135-7 c5 W I O�+4- ❑Addition of new motorload of system.
( ) IOOHP or more. ❑"A'• "E" "1.2""1-3„
City/State/ZIP: �t Gtrd �` 6i72 .4 ❑Six or more residential units. occupancy.
S ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 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:
Inscription I Qty. I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
DESCRIPTION OF WORK add'l 500 sq.ft.or portion 33.92 1
Limited energy,residential
�( tir `e �` (with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT
Services or feeders installation,alteration,and/or relocation
Name: R f...,Kt -CI M G )t,)IjM.�iIp�l 200 amps or less 100.70 2
Address: I9 3 , ,`w I Ip� {'}` rSA i I ,/�-) 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: ((j1)..JCk i 0IL Al1,
'(!1i"'_• 601 amps to 1,000 amps 301.04 2
Phone:( ) U Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
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 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
�+ ��R A.Fee for branch circuits with
Business name:
SQ.111C wJ h� above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first I 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
Email: dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: ++k^^ed I u NQ ��P .6,iC 1L oix,o,M]uni.Aul i Sign or outline lighting g 67.84 2
Address: ,L,l Signal circuit(s)or limited-energy
I110�5 5(.0 (Q(y ` A-Lt il ML/ lru panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: ?c,t4 la 4 0-i Gi'7u2 Each additional inspection over allowable in any of the above
�J / Additional inspection(I hr min) 66.25/hr
Phone:(i)3 ) 5'9 (Z.(33 Fax:( ) Investigation(1 hr min) 90.00/fir
Email: 6'e J C I,vtx d,1, I✓`�0 C `-C-CN/` Industrial plant(1 hr min) 78.18/hr
r�pp qq Inspections for which no fee is
CCB Lic.: 1%s L{'.)1� Electrical Lie.: C-I Suprv.Lic.: CJ S 203 specifically listed C/i hr min) 90.00/hr
Su rv.Electrician signature, ELECTRICAL PERMIT.FEES
p gnature,required:
Y � � Date: 0 rik—\ASubtotal: 51
Print name: � q.I�ul �u23 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
JAuthorized signature: TOTAL PERMIT FEE: (.ftaq
This permit application expires if a permit is not obtained within 180
Print name: Y.l�L 1- 'jl ,n s Date: 1,-I.ui I.�j'L days after it has been accepted as complete.
v ' Number of inspections allowed per permit.
1,113uilding1Permits\ELC_PermitApp_ELR_ERE.dec Rev 06/17/2015 4404615T(11/05/CO
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
FEE SCHEDULE
RESIDENTIAL WORK ONLY: 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 IS 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
0 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
0
>100 kva-no additional charge 0.0 3
Vacuum Systems* Each additional inspection over allowable in any of the above:
Each additional inspection is 66.25/hr
❑ Other: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('%hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONLY: 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
❑ 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
Hauilding0lerninELC_Perrni5App_ELR ERE.doc Rev 06/17/2015