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Permit (22) N CITY OF TIGARD ELECTRICAL PERMIT 'P 1 11, COMMUNITY DEVELOPMENT Permit#: ELC2023-00310 T j G R0 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 5/17/2023 Parcel: 2S103DD00404 Jurisdiction: Tigard Site address: 10685 SW FAIRHAVEN ST Project: Egleston Subdivision: FAIRHAVEN COURT Lot: 4 Project Description: (3)branch circuits for floor heat and bathroom remodel. Contractor: NEXT LEVEL ELECTRIC Owner: EGLESTON, DAVID ROY&CINDY LOU 58775 LONE PINE RD 10685 SW FAIRHAVEN ST VERNONIA, OR 97064 TIGARD, OR 97223 PHONE: 971-341-9466 PHONE: FAX: FEES Quantity Description Date Amount 3 crt Branch Circuits wo/Purchase 05/17/2023 $71.02 Specifics:, Service or Feeder Type of Use: SF 1 ea 12%State Surcharge- 05/17/2023 $8.52 Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $79.54 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Co-a. - . all o - applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days o iss.• -, or ork is suspended for more the 180 days. ATTENTION: Oregon law requires you to folio e rules adopted by the Oregon Utility Notifi.<tio - ter. o-- rul- are et forth in OAR 952-001-0010 throuah OA 952-001-0090. You may obtain coov of�he rules or direct auestions to OUNC by callina 83.2. •87 or 1,:1�. 1 � 4.�j Issued By: 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 rt,iz 01.1 ( I.; I si ()NIA A Cityo Ti and Received Date/By: ,�/i 7/23 Pennit#: -3 cj ' 13125 SW Hall Blvd.,Tigard,OR 97 Plan Review 6_- ®' Phone: 503.718.2439 Fax: 503.598 E C E I` Date/By: Related Permit 4:�,Qa. a ��j Inspection Line: 503.639.4175 ' `` V Read Date/By: Juris: L 6 T I G A R l:) y ® See Page 2 or Internet: www.tigard-or.gov a Notified/Method: -73 Supplemental Information TYPE OF WORMAY ! 6 2023 "PLAIN REVIEW ❑New construction : Addition/alteratiQ lif 1'ra'CARD r� Please check all that apply(submit 1 sets of plans w/items checked): (i l CA i D 0 Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition El Other: �,^,,, D��+�iaN where the available fault current 0 Marinas and boatyards. CATEGORY OF CO �t1 exceeds 10,000 amps at 150 volts or 0 Floating buildings. RI 1-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 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived • Job site address: Job#:/230�S' Q�+— ❑Addition of new motor load of system. 0 6 O S eS Gtf tq i j' h a 11en 100HP or more. ❑ A, E 1.2„ 1.3 City/State/ZIP: �.� ©� 7223 4 ❑Six or more residential units. occupancy. ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or snore. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qtr. 1 Each I Total New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft,or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 �y DESCRIPTION OF WORK Limited energy, /ft.E/rKetSiik�' �jR .ilea t y�� (with above eresidential 75.00 2 sq.ft.) Limited energy,multi-family 75.00 2 ifew or`k (a) .5'w;1 4er .r44.o1 (2) dulietj residential(with above sq.ft.) ❑ TENANT Renewable Energy 0 See Page 2 ® PROPERTY OWNER Services or feeders installation,alteration,and/or relocation Name: Dela t c ( C I h of 1 cery it s kw, 200 amps or less 100.70 2 Address: 106(5- ,g(,v tri;;e It Ave n 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: ) illarOf / OR 972.3 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or 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 ® APPLICANT CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: Zvi N puo4 IL above service or feeder fee, 7.42 2 / each branch circuit Contact name: /lq, t(1 Lt/at�✓ B.Fee for branch circuits without Address: Q3 5E i 72.4 :Awe Sy;it -ff (a p service or feeder fee,first 56.18 I 2 r t r O branch circuit City/State/Zli. t d Q. 979 PG_ Each add'1 branch circuit 7.42 2. 2 P 7 N f Miscellaneous(service or feeder not included) Phone:(.5.03) 'g - et( et V r Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email:bid tot I),.l.y1O41 q / e4, , Gm J { Reconnect only 67.84 2 CON CTOR Pump or irrigation circle 67.84 2 Business name: Jf l e-KT t'eV e I e I eC-4^t IL Sign or outline lighting 67.84 2 Address: po B b X 297 Signal t(s)or limited-energy 0 See Page 2 2 panel,alteration,or extension. City/State/ZIP: Vern 0 M i C. 77g p u Each additional inspection over allowable in any of the above / la ! Additional inspection(I hr min) 66.25/hr Phone:IV)3 //— 7 if 4 Fax:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lic.:214 lot g Electrical Lic.: Attl Suprv.Lic.• ( ?' (' S specifically listed(Yz hr min) 90.00/hr S ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: gl� � 1* 1I1V Subtotal: Print name: t3 Wig 6 y)1I.I�e ke Date: © -..to 7-43 El Review Required(25%of permit fee): �1 State surcharge(12%of permit fee): Authorized signatu TOTAL PERMIT FEE: 7 f. r--1, r c��/o� This permit application expires if a permit is not obtained within/80 Print name: l 4. �. Jlie e�, Date: D •-/7i. days after it has been accepted as complete. * Number of inspections allowed per permit. 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(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 DescriFee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5,01 to 15 kva 133.56 2 0 Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: 0 Burglar Alarm 25.01 to 50 kva 301,04 2 0 Garage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 C 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: C Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is specifically listed('A hr min) 90.00/hr COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.Q0 Subtotal(Enter on Page I): (SEE OAR 918-309-0000) * Number of inspections allowed per permit. Check Type of Work Involved: ❑ A• udio and Stereo Systems ❑ Boiler Controls 0 C• lock Systems E Data Telecommunication Installation ❑ F• ire Alarm Installation ❑ H• VAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls E Outdoor Landscape Lighting* E Protective Signaling 0 O• ther: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:1Building\Permits\ELC PermitApp_ELR ERE,doc Rev 06/17/2015