Permit Support Document (9) SiD
CITY OF TIGARD ELECTRICAL PERMIT
- COMMUNITY DEVELOPMENT Permit#: ELC2023-00395
Date Issued: 6/27/2023
T16Ati1D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 23110AD01800
Jurisdiction: Tigard
Site address: 14630 SW 106TH AVE
Project: DUECK Subdivision: LANG HILL Lot: 15
Project Description: (4)branch circuits for kitchen remodel.REPRINT:6/28/2023 adding(5)circuits.
Contractor: OWNER Owner: DUECK,STEPHAN&STEPHANIE
14630 SW 106TH AVE
TIGARD,OR 97224
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
4 Crt Branch Circuits wo/Purchase 06/27/2023 $78.44
Specifics: Service or Feeder
1 ea 12%State Surcharge- 06/27/2023 $9.41
Type of Use: SF Electrical
Class of Work: ALT 5 crt Branch Circuits w/Purchase 06/28/2023 $37.10
Service or Feeder
Type of Const: 0 ea 12%State Surcharge- 06/28/2023 $4.45
Occupancy Grp:
Electrical
Total $129.40
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 wi approved plans. This permit will expire if work is not started within 180 days of issue. :, or if work i su nded for more t
180 days. ATTENTIO.. Or- on law r-• a to follow the rules adopted by the Oregon Utility Notification - er. T e r le t forth in 0
952-001-0010 lhro • OA" -52-001-05-•. >51liobtain a coov of the rules or direct questions to OUNC by calling 503.23 •87 S 1.8.-..332. 44.
Issued B Permittee 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
CI o Tigard Received �p �q AP
l
`� g Date/By: It I�� 'Tlr Permit#: ��C-GZOG.
114
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 11 U '9
Phone: 503.718.2439 Fax: 503.598.1960 , I pate/By: ��' Related Permit#: 00 3'�/
of
Inspection Line: 503.639.4175 1 ` _ Ready Date/By: luris: 0 See Page 2 for
Ci 71ARD Internet wwnv.tigard-orgov 1, rI�q t
�-�/ TYPE OF WOR1101 V ll t Notified/Method: Supplemental Information
V PLAN REVIEW
❑New construction k Addition/alteration/replacement Please check all That apply(submit 2 sets of plans vs/items checked).
El Demolition E Other: IDService or feeder 400 amps or more ❑Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
1-and 2-familydwellingCommercial/industrial less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ ❑ACGCSSOry budding amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other:
❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
/ ID Addition of new motor load of system.
Job#: Job silc address: /G/t030 /�� r /0' rife
100HP or more. ❑"A","E","I-2","1-3",
City/State/ZIP: ,,,/��'' {n/ ❑Six or more residential units. occupancy.
g p ' ` j „� 4, l ❑Health-care facilities. Cl RecreSupplyalpars.
voltage for more than
�) T 6� Cl Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: [/i5'ArZJI/J FEE SCHEDULE
/ Description I 0t1. I Each I Total I
y� ' ( 4 �! / New residential ngle-or multi-family dwelling unit.
ld
Subdivision: (/�7 L /r 6 Lot#. Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
�,��/�y y 'y� `_ ' (with above sq.ft.) 75.00 2
t lanl. 5 (JJL1 +I Q �N 1. _ F IY J. Limited energy,multi-family 75.00 2
(� residential(with above sq.ft.)
Renewable Energy ❑ Sec Page 2
PROPERTY OWNER ❑ TENANT . Services or feeders installation,alteration,and/or relocation
Name: C I i n� i'�1uj a)t 1/ 200 amps or less 100.70 2
Address: l 4(0 6 SW {Diom-4Q r rn 201 amps to 400 amps 133.56 2
—i J {� -r�KJ' ,j 401 amps to 600 amps 200.34 2
City/State/ZIP: 4' d I Q a. (i i�j/( 4 601 amps to 1,000 amps 301.04 2
Phone:(4 ( ) 4 II - -b1(e I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
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
APPLICANT '❑ CONTACT PERSON < Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: \ir .nn n of I . above service or feeder fee, 5 7.42 2
VVVtIWNM��'������CCCd vV each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first
Address: branch circuit 56.18 2
City/State/ZIP: Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder
Email: 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. ❑ See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP:
Additional inspection(I hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email:
Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed CA,hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: 5 r.p c-}-,41-1)/j IC Date:6 -20 -2 S days after it has been accepted as complete.
" Number of inspections allowed per permit.
I:1BuildinglPemlits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 4404615T(11/05/COM/WEB
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 Qfv. I Each I Total
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
I I Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n 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
charged at an hourly(I hr min)
Inspections for which no fee is 90.00'hr
specifically listed I%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
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
7 Intercom and Paging Systems
1 Landscape Irrigation Control*
7 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
I:\Budding\Permits\ELC_PermilApp_ELR_ERE.do<Rev 06117/2015