Permit (29) CITY OF TIGARD ELECTRICAL PERMIT
[t COMMUNITY DEVELOPMENT Permit#: ELC2023-00469
T[GARD, 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/8/2023
Parcel: 2S111AC04800
Jurisdiction: Tigard
Site address: 14855 SW 92ND AVE
Project: LEWIS Subdivision: LAUNALYNDA PARK Lot: 16
Project Description: Panel replacement and (4)branch circuits.
Contractor: DREAMHOUSE ELECTRIC LLC Owner: LEWIS, NICHOLAS D &ABIGAIL ANNE OLDSHUE
221 SW MOONRIDGE PL 14855 SW 92ND AVE
PORLAND, OR 97225 TIGARD, OR 97224
PHONE:
PHONE: 503-648-5144
FAX: 503-648-9723
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 08/08/2023 $100.70
Specifics:
amps or less
4 crt Branch Circuits w/Purchase 08/08/2023 $29.68
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 08/08/2023 $15.65
Type of Const: Electrical
Occupancy Grp:
Total $146.03
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 throuuah�QR 952-001-0090. You may gin a cony oflTi les or direct Questions to OUNC by calling 503.232.1987 0 1.80 .3322344.
Issued By:� ermittee 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 RecE1Ved Permit No.:
114 CEIVE D Davy: Y/(1i3 4 _ ca.7 l '''3_ uo l
�- 13125 SW Hall Blvd.,Tigard,OR 97 ph R
Phone: 503.718.2439 Fax: 503.598, 9 Date/By: Other Permit.
.0 i( -F t� Inspection Line: 503.639.4175 _ Date Ready/By: Joris: Pi See Page 2 for
Internet: www.tigard-or.gov Notified/Method: /�rl..L��J�-j Supplemental Information
/^J
PE OF WORArr, re 7'1 ntJf` PLAN REVIEW
0 New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
❑DemohtlOn0 Service or feeder 400 amps or more 0 Building over three stories,
0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at I50'volts or 0 Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
4.,-.- ❑Addition of new motor load of ❑"A" "E" "l-2" "I-3„
Job no.: Job site address: r>� 100HP or more. occupancy.
i l 1 T:5`> �S W �2 Avg__ ❑Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: --r, eQ.- ❑Health-care facilities. CI Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: Ft`1rN_l_e_,..JiC 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I '
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Tax map/parcel no.: Ea add'l 500 sq.ft.or portion 33.92 1
Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
p
('.i'Yr=SZe� P"cam:4\ t -c0 c� G`Ru.?'`Y c', 1�I residential(with above sq.ft.)
Services or feeders installation,alteration,and/or relocation
200 amps or less I 100.70 I t=lc) 2
PROPERTY OWNER 0 TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
City/State/ZIP: relocation
Phone:( ) Fax:( ) 200 amps or less 59.36 1
— 201 amps to 400 amps 125.08 2
Owner installation:This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401Branch circuits—new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
APPLICANT 0 CONTACT PERSON above service or feeder fee, u 7.42 Lq �g 2
each branch circuit -1
Business name: B.Fee for branch circuits without
.roc,,,,,
't Q"rn �fit" 2`P-':� '�"' — service or feeder fee,first 56.18 2
Contact name: branch circuit
Each add'!branch circuit 7.42 2
Address: Miscellaneous(service or feeder not included)
CitylState/ZIP: Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Phone:( ) Fax::( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s)or limited-energy
Business name: DreamHouse Electric,LLC panel,alteration,or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 221 SW Moonrldge Place Additional inspection(I hr min) 66.25/hr
City/State/ZIP: Portland,OR 97225 Investigation(1 hr min) 66.25/hr
Phone:(503) 519-6711 Fax:(503)648-9723 Industrial plant(I hr min) 78.18/hr
CCB Lic,: 1%726 Electrical L' .. prv,Lie.: 4560S Inspections for which no fee is 90.00/hr
specifically listed(1/2hr min) I
Suprv.Electrician signature,required. ELECTRICAL PERMIT FEES
Subtotal: 13C ,3
Print name: Chris Mahoney Date: Plan review(25%of permit fee):
Authorized signature: State surcharge(12%of permit fee):
TOTAL PERMIT FE} f UY,03
Print name: Date:
I:IBuilding1PerrtitslELC-PmnitApp.doc 07/01/10 440-4615T(11/05/COM/WEB