Permit (12) CITY OF TIGARD ELECTRICAL PERMIT
'III ' COMMUNITY DEVELOPMENT Permit#: ELC2023-00307
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 5/16/2023
T[ �11 .19 g Parcel: 2S111BD01601
Jurisdiction: Tigard
Site address: 14815 SW 98TH AVE
Project: Rogers Subdivision: ALDERBROOK FARM
Lot: 5
Project Description: Replacing(1)200 amp service and adding(2)branch circuits.
Contractor: JARMER ELECTRIC INC Owner: ROGERS, MICHAEL R&ELIZABETH A
5105 SW 45TH AVE#200 14815 SW 98TH AVE
PORTLAND, OR 97221 TIGARD, OR 97224
PHONE: 503-246-5381 PHONE:
FAX: 503-244-8037
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 05/16/2023 $100.70
Specifics: amps or less
2 crt Branch Circuits w/Purchase 05/16/2023 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 05/16/2023 $13.86
Type of Const: Electrical
Occupancy Grp:
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 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• ires you to •low the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 throu• - 952-1J690. .0 av obt�,a coov of.or direct Questions to OUNC by callina 503. 2.1987 or 1.800.332.2344 ems, �('
Issued By: .. /� I•A i.Lm/ Permittee Signature: �L�%�1l L
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 ()I I I( 1. 1 `'I:O\1.1
City of Tigard I Ef o Date/By: 7 ReceivedRECE y^-7 / , 4 Mr.4U2,3- i/3 2 7
14 r 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
' .` Phone: 503.718.2439 Fax: 503.598.1960 Ivi A Y 1 6 2023 Date/By: Related Permit:#:
I I G A It I7 Inspection Line: 503.639.4175 Ready Date/By: Juris: el See Page 2 for
Internet: www.tigard-or.goy �i n� r�r (� Notified/Method: Supplemental Information+
TYPE OF WO
1ILDINC DIVISInN PLAN,REVIEW
0 New construction dditton/alteration/replacement Please check all that apply(submit Z sets of plans w/items checked):
❑Demolition ether: ❑Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
174-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
■ Multi-family 0 Master builder 0 Other:
❑Fire pump. 0 Installation of a 50 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: �t, 0 Addition of new motor load of system.
pp Job site address: )If i 16 S0 j 4 - lo01tp or more. D
City/State/ZIP: Il (,j'-) LZ(f ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: (Ai tbte."..Y,,fiw IN.
❑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
Description j Qty. I Each I Total i
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'!500 sq.ft.or portion _ 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
V ,�4 . a ®� (with above sq.ft.)
Y L Ci V °l `w'i � � �,�'tYCcr Limited energy,multi-family
) l f ... r t d P r- c residential(with above sq.ft.) 75.00 2
Q PROPERTY OWNER I EN CANT Renewable Ener. 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: -]� 200 amps or less I 100.70 in Vs 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 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
Email:
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
0 APPLICANT 1 0 CONTACT PERSON Branch circuits-e new,alteration,or extension,per panel
��./ 1 A,Fee for branch circuits with
Business name: (-NI M"4r G w above service or feeder fee, 7.42 )if , 2
each branch circuit
Contact name: Ni 44 44,4 _ B.Fee for branch circuits withoid - -
Address: / service or feeder fee,first
40 Vytl �{ �" branch circuit 56.18 2
City/State/ZIP: ' .----- o. i '7 Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( II3 Z y(, & I Fax::( ) Each manufactured or modular 67.84 2
Email: --)-_1 i„- —J J C r-i..-#j , I V{/'� dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: _ / Li-EonSign or outline lighting 67.84 2
Address: �J Signal circuits)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 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 Lic.: 6. it Electrical Lic.: t' Suprv.Lic.: v � .S specifically listed(/z hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: _ Subtotal: _
Print name: ti Date: £l e6 z 0 Plan Review Required(25%of permit fee):
f 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: Date: days after it has been accepted as complete.
Number of inspections allowed per permit
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