Permit (38) 114 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2023-00480
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/12/2023
Parcel: 2S108DC13100
Jurisdiction: Tigard
Site address: 15901 SW BLUEWATER TER
Project: Future River Terrace Park Subdivision: RIVER TERRACE CROSSING Lot: 0
Project Description: (1)branch circuit for irrigation controller.
Contractor: EPLING ELECTRIC Owner: TIGARD, CITY OF
1295 SE 62ND AVE 13125 SW HALL BLVD
HILLSBORO, OR 97123 TIGARD, OR 97223
PHONE: 971-236-2175 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 08/12/2023 $56.18
Specifics:
Service or Feeder
1 ea 12%State Surcharge- 08/12/2023 $6.74
Type of Use: COM Electrical
Class of Work: NEW
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the
180 days. ATTENTION: Oregon law re tyres you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 throualy014R 952-001-0090.�'Yo av obtain a coov of the rules or direct Questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
/ iZ3
Issued By: � v .�� J %C,C Permittee Signature: G`Q{�1
� 1 Covl.
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC'N Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m,for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Eke-- trkal Permit Application RECEIVE
°IIICity of Tigard Doi 14v 2 T' ` o
13125 SW Hall I3lvd..'figard,OR 97223 1)atul3v !� V a / Peanut s.Gi t �Q 7j"(��
_.:a 1 0 2023 Plan Resew
Phone: 503.718.2439 Fax. 503.598,1960 ' Related Y xmii a
Date/Hy
TIGARD Inspuctiwi Line: 503.639.4175 Ready DaterHy / gars S see Page x for
Internet: www.hgardor.gn CITY OFTIGAR(D� Notified/Method f fi (ate
JlLDING.QiViSI Supplemental Information
❑New TYPE OF WO r r?t- I if i 'E$N REYIEW ; ,,,
�nSlrnctlUn > ' ,
7��__ re Addition/alteration/replacement Please chock all that apply(submit/seta of plans wliters checked)
El Dt volition
'" -^- Otllcr. ❑Service or fewer 400 amps or more 0 Building over three stones_
where the available fault culent 0 Marinas and boatyards.
17iGOTtY OF coNsmyc'IION excacda 10,000 amµ:al 150 molts or ❑Flcatmg buildings.
❑u I and 2-family dwelling I$Commeiclai/industrial1�,to gronrd.or exceeds 14,000 ❑eommeee al-nr
Multi-fanlil 0Accessory building agrtcaiturat
y ❑Master builder ❑Other: ;::::pump
all taper nnaaaao a buildings
JOB SITE INFO ❑F re pump 0 Installation of 150 KVA or
Jnh it 1211IATION AND t,OCATION ❑i mergenury sysem larger separately derived
Job site address: (5� ` S`a 1 R tt D Addition of new recto load
of system
I t}/Sta(4/ s• -+ � r IWkiY or more ❑"A","[:"',"1.2 "I-3",
• `�arCt (�� Ql� 7 Z4 0 Six or more residential units occupancy
Suite/bld 1 T ❑Iteal h-care facilities
g./aP rections to0 Recreational vehicle parka.
ProJecl name: a ���_ 4Cv !ir�t( ❑Hazardous locations.
0 Supply voltage for more than
CrQSS street/directions ('' C �11
0 Stavrca or feeder - amps ,more 600 volts nominal.
Jobsltc:
FEES IIEDULE
Derrnnno. I the. 1 I aU I Taal 1
Subdivision: 1 New residential single-or multi-family dwelling trait.
'r&x I Lot#: Includes attached garage.
"'•^' y i I.OW aq.fL or Iran 168.54 4
IMlDESCRIPTION OF WORK La.add'I aq.es or potion 33.92 1
Limited energy,residential .
'Cr— v' 1 4!� Cll (with above sq.let.) 75.00 2
Limited energy,muhi-family
residential above eq.ft.) 75.00 2
Q FROPERT1f OWNER ❑ TENANT Renewable Energy ❑ See Page 2
Name: Services or feeders inatallationtalterntion,and/or relocation
Address:
200 amps or less 100.70 2
201 amps to 400 amps 133.56 City/State/ZIP: 401 amps to 600 amps 2
200.34 2
Phone:( ) 601 amps to 1,000 amps 301.04
Fax:( ) Over 1,000 an 2
Email: W or volts 55226 2
Temporary services or feeders installation,alteration,and/or
Owner installation: This installation is bean made on propertyrelocation
intended for sale,lease,rent,or exchange,according to ORS 447,449,t6 0,and 701.not 2001 amps oro leas 59.36
20l amps to 400 amps 1
Owner signature: 125.08 2
Date: 401 amps to 599 eases
168
(.APPLICANT 0 CONTACT PERSON Branch circuits—newr alteretio orextension4 r 2
r
t5usmess name: [ Lr 1 f- l �1 A Fee for branch circuits with trek
C" 3•— above service or feeder fee,
Contact name: ,`\`� �,` each branch circuit 7.42 2
Address: ‘2_ B.Foe for branch circuits without
l a 2►`u _ service or feeder fee,first �j
City/State/ZIP: � e i b t �R G1-11�3 Match circuit 1 56.18 Sk'•►CJ 2
-}i
Each add't branch oilcan
7.Phone:(CO )23�- 21-1 Fax: :( ) Miscellaneous service or feeder not included
2
);mall. a fl �y 1i 1- h manufacture!or modular
OTIy 1. YxG( {kL--j3 r sp m dwells service and/or feeder 67.84
Rooemneut only 2
CONTRACTOR 67.84
Business name: ( ( ` C.
Pump or irrigation circle 2
p Sign or outline lighting 67.84 2
Address: 1 2'1 5 .S E W Z � Signal circuit(s) 67.84 2
to limited-energy
City/Stale/ZIP: `� 0�() 6 �, e! altcntie orextcnsic ❑ eePage2 2
��tt ` Each additional Iris over alFowahk lit a
c cil i 3 ( Additions,inn ( min) of tlae abo.Y
Phone: )Z i"1 Fax: ) lemon 1 hr 66.23/hr
� ```�.,,`� Investigation(l hr min)
Email: O1t� I I ( c m 90.00/nr
Industrial plant(I hr min)
5� 78.18/hr
CCB Lie.: Electrical Lic.: C. Su ry Lic �s � 10ll for"iio1i r fee a
Electrician signature,required: P 5�45 fecal} listed r.4 basin 90.00lhr
Supra, Mark A. Epling ro a a ELECTRICAL pit it FEES
1�jAt llatllC: �YIL \l� Date g.�8/9/23 oc
Subtotal:
D Plan Review Requited(25°Ja of permit ice):
Mark A. Epling .".t3t Z't ,. State surcharge(12%of permit fee): ^�
Audiori2ed sigk>dture: Po. TOTAL PERMITr1
print �Y k- ��1 lY`° Date: 8/9/23 rhis application napkin ira permit net obtained wi-thin g
permit
penpApr_ELK ERE.dao Rev O6/17/2013 • n after it Ira been accepted as complete 0
klmm
a Number of Inspections allowed per perm&
I.iRul4aa' 440-4615111 UOLCO,NAVEn