Permit (11) CITY OF TIGARD ELECTRICAL PERMIT
t a COMMUNITY DEVELOPMENT Permit#: ELC2023-00554
Date Issued: 9/18/2023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S 104AD00300
Jurisdiction: Tigard
Site address: 12775 SW MARIE CT
Project: Anderson Subdivision: BELLWOOD
Lot: 12
Project Description: (1)200 amp meter main with(4)branch circuits.
Contractor: TRUE BLUE ELECTRICAL CONSTRUCTION LLC Owner: ANDERSON, JAIMI S &SPENCER D
PO BOX 230030 12775 SW MARIE CT
TIGARD, OR 97281-0030 TIGARD, OR 97223
PHONE: 971-280-2960 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 09/18/2023 $100.70
Specifics:
amps or less
4 crt Branch Circuits w/Purchase 09/18/2023 $29.68
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 09/18/2023 $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 iss ance, 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 enter. Those rules are set forth in OAR
952-001-0010 throuoh R 952-001-0090.� You m/o)btain of the rules or direct questions to OUNC by callina 503.232. 7 or 1.800.332.2344.
Issued By: ` "' �r7"` 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.
City Of Tigard 13125 SW Hall Blvd.,Tiarcl,OR 97223 ere xd
g ECEIVED EE.m q/ /�3 Pemvt ,`;� , ._G►t ��
Phone: 503.718.2439 Fax: 503.598.1 Bv. Related Permit tr: (7 2)i? .. E)144
Inspection Line: 503.639.4175 1 Q 2023 Ready Da=.By l�uis: lJ See Page 2 for W
I C;.\r`1) Internet www.tigard-or-goo SEP U Notifiedllciethod: Supplemental Information
- -
WORK 'SIG per: ;. :` ,� 1� .
❑New construction lhotl/alleninotl/C �71NZA DIVISION�7I0N Please check all that apply(submit sets of plans wriicros checked)
❑Demolition Other
11-- ❑Service or feeder 400 amps or more ❑Building ovrer three stories
_ where the available fault current ❑Marinas and boatyards
.
} CATEGORY '-fi'( STRUC11O - exceeds 10,000 amps at 150 volts or ❑Floating buildings
A1-and 2-family dwelling 0 Comtnel'cial/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 ❑Fire pump. 0 lasts Motion of 150 KVA or
- ,SITE, T N•WO, 41tCATLO I- 0Emergency system. larger separately derived
Job#: I lob site address: 0addition of new motor load of system
v i S S� 1 1..�[,�—^ 100tip or more. ❑"A".
City/State/ZIP: ❑Six or more resident al units. occupancy.
T r! t°- cQ ,fl �17> ❑Healthcare facilities ❑Recreational vehicle parks.
Suitelbldg./apt.#: � ( Project name: '(ty� ` C•, ❑hazardous locations. 0 Supply voltage for more than
I "'��/ w �� 0 Service or feeder 600 6L10 volts nominal
amps or more
Cross street/directions to job site: 1- S',4"" / t,J 0.( yt+ti�
» ice 1 on. 1 Each 1 Toni 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
Ea.add1500 sq.R or portion
33.92 1
'"DESCRIP:FIO OF limited energy,residential 75.00 2
0 � 1N1tC��vN�t"1 (with energy,sq.multi
Zt� Limited 2
residential(with above sq.ft.) 75.00
Renewable Energy 0 See Page 2
:'1- ROPE Off' f# z TENANT- Services or feeders installation,alteration,and/or relocation
Name: CJ P.p v car yckply ,,.-‘ 200 amps or Less f 100.70 )pp 70 2
Address: .Z, 1 5 Cip— _vuz- L ( 401 amps to 600 amps 200.34 2
�j[� �1' 401 amps[0 600 amps 200.34 2
City/State/ZIP: —�t,S,P., R- g 1223 601 amps to 1,000 amps 301.04 2
Phone: ( " Fax:( ) over 1,000 amps or volts 552.26 2
( Temporary services or feeders installation,alteration,and/or
q
Email: I ?i .32?�(p 04' 1 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
DT a. Branch tirenits-new,alteration,or eztenaon,per panel
A Fee for bruwh eiicuils with '''///
Business name: above service or feeder fee, 7.42 Zj (pg 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,fast 56.18 2
Address: branch circuit
City/State/ZIP: Each add"'branch circuit 7.42 2
Miscellaneous us(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
tv-'QIVTItriTT ki - Pump or imgation citric 67.84 2
Business name: ---1-1(ttiL 13(K., y``� t (c- Sign or outline lighting 67.84 2
signet cacuit(s)er limited-energy 0 See Page 2 2
Address: pc, (, Z 2 3c) panel,alteration,or extension.
Citt,-'/StatelZIP: —f Each C 0IZ C l_ —��d Adch additional inspection over allowable in any of the above
t Additional inspeotion(1 hr tam) 66.25/hr
Phone:Ca O 2 So —IC/(0 Q Fax:( ) Investigation(1 hr min) 90.00/hr
t y Industrial plant(1 hr min) 78.18/hr
Email: cc q v. 0 C nil 1 • Ce)1vN Inspections for which no fee is
lly listed '/a hr min 90.00/hr
CCB Lie.. 9130 Electrical Lic.ie_i<6too Suprv.Lie.: 4"c ssa ( >
Suprv.Electrician sigi 1uired: 7 I l. n Subtotal:
l 3a .3
Print name: c 5 11 f�Ij•ti iL Date—k 1S- 2-3 Plan Review Required(2596 of gamin fee):
464 Stan:surcharge(1295 of gamin fig): IS.(c�
Authorized signature: TOTAL PERMIT FEE: 1 if Go r
This permit application expires if a permit is not obtained ithin
Print name: Date: days after it has been accepted as complete.
Idc*a ra.as r CI HAIL tipapuLauon—t,iuy VI x Igor u
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
ICESIDENTIAL WORICONLY: btu ,
Fee for all residential systems combined: $75.00 °.Apt"° Qty. 1 Each I Total I *
Renewable electrical energy systems:
Check Type of Work Involved: levi or less Ic10_702
5.01 to 15 kva 133.56 2
❑ A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2
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
Garage Door Opener >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating,Ventilation and Air Conditioning Solar generation systems In excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ V• acuum Systems* ?100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66:25i hr 1
charged at an hourly(I hr min)
Inspections for which no fee is 90,00;hr
specifically listed(k hr min)
COMMERCIAL WORK ONLY -
-EuterRiAL te.l
Fee for each commercial system: $75.00 Subtotal(Fula on Page 1):
(SEE OAR 918-309-0004) * Number of raspectons allowed per pe m t
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ B• oiler Controls
❑ Clock Systems
❑ D• ata Telecommunication Installation
❑ F• ire 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