Permit (2) CITY OF TIGARD ELECTRICAL PERMIT
III ' COMMUNITY DEVELOPMENT Permit#: ELC2023-00652
T I t A R I) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/1/2023
Parcel: 1 S133DB09600
Jurisdiction: Tigard
Site address: 13213 SW SUMMERWOOD DR
Project: Cournoyer Subdivision:?CHOLLS FERRY ROAD TOWNHOME; Lot: 22
Project Description: (2)branch circuits for hot tub and EV charger.
Contractor: OWNER Owner: COURNOYER, MICHAEL R&PAMELA L
13213 SW SUMMERWOOD DR
TIGARD,OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 11/01/2023 $63.60
Specifics: Service or Feeder
Type of Use: SF 1 ea 12%State Surcharge- 11/01/2023 $7.63
Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 wo is suspended for more the
180 days. ATTENTION: Or la requires you to follow the rules adopted by the Oregon Utility Notification Center. Th•_- rule -re set forth in OAR
952-001-0010 through 95 1-0090. You may o of the rules or direct auestions to OUNC by calling 5r 8�or .8r . .'..
Issued By:
��% Permittee Signature: � F /(✓
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 Received 1\I,'1oi .NI) 'GtG WTi ,006Sv
g RECEIVE) Receiv Permit#: q
14 't 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Jl
Phone: 503.718.2439 Fax: 503.598.1 V 1 2023 Date/13y: Related Permit#:
Inspection Line: 503 639.4175 Ready Date/By: �A Suns: H See Page 2 for
I 1 G A R L) Internet: www tigar d or gov C T! Notified/Method: ►l no Supplemental Information
W�.rt _
ti p
❑New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition El Other: where the available fault current;, , 0 Marinas and boatyards.
Tit '. exceeds 10,000 amps at 150 volts or
"' "�:.: .. _ .., � �' w. ��� ,3�. �� ._�.. .-� P 0 Floating buildings.
1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
CI
r ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
��MUlti family $ ❑Master�bU�ilde0 Emergency system.
❑ larger separately derived
Addition of new motor load of system.
Job#: Job site address: gpi 3 51,1 5'�,,s1,'l #s e.. or l oOP or more. ❑"A",°`E",°`1-2","1-3",
City/State/ZIP: /l � � s ❑Six or more residential units. occupancy.
/ 4/ 0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ❑Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: _ om, . ',r ,., „,
M t,.
Description Qty. i Each f Total
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.add'l 500 sq.ft.or portion 33.92 1
VAtt:art'" . ...v 1a .. ,, ,- tra ..f . - AO Limited energy,residential
'11doiri 1- /J
- ho � eccArrGk7ei/Ce- (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
r -' i1 - - . Services or feeders installation,alteration,and/or relocation
Name: /4 h co,,,Y-/ILoyi r 200 amps or less 100.70 2
Address: /?a/3 5 0Cv,err 201 amps to 400 amps 133.56 2
J �!` 401 amps to 600 amps 200.34 2
City/State/ZIP: i/ eva 1Z23 601 amps to 1,000 amps 301.04 2
Phone:(5'4/ ) atj(o_/0/f a- Fax:( ) Over 1,000 amps or volts I 552.26 I 12
Temporary services or feeders installation,alteration,and/or
Email:M coarivo y f ./1iY -J, 1 L. 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 e c ge,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: dam' Date: 401 amps to 599 amps 168.54 2
F,. I�s, r - x Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: 5/���"/" - (�(�e above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular
Email:
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
� �,g�-- /�•r,G...` a- .,��= Pump or irrigation circle 67.84 2
Business name: )� �y a*' �✓�t,/ ,(j_ 3 e Y ._— Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. ❑ See Page 2 2
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
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed("' " ' w '/2 hr nun) 90.00/hr
t , 4�'r . �?, , r`i -
Suprv.Electrician signature,required: ,~ -.
Subtotal: b3.60
Print name: Date: ❑Plan Review Required(25%of permit fee):
///J C.. State surcharge(12%of permit fee): 1 ,63
Authorized signature:��` � �,� TOTAL PERMIT FEE: 1 tl.2'
, / � This permit application expires if a permit is not obtained within 180
Print name: i L 5teri a ci 2i' Date: 0/7.2C.,2„..3 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELCPermitApp_ELR_ERE.doc Rev 06/17015 440-411/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
Description I Qty. I Each
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
❑ A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind 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
❑ G• arage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ H• eating,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:
❑ Each additional inspection is 66.25/hr 1
Other: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/z hr min
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
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire 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
I:\Building\Permits\ELC_PermitApp_ELR ERE.doc Rev 06/17/2015
Property Owner Statement RECEIVED
Regarding Construction Responsibilitietiov 1 202.3
Oregon Law requires residential construction permit applicants who are not licens- he
r
Construction Contractors Board to sign the following statement before a buildin.,. : • i �
issued. (ORS 701.325 (2)) I d
a !Vi !( L,
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement.This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and
p my general contractor is:
ia ! �/ /�/ � l v oL�
me CCB# Expirati n Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
,.., reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
jej�1/-�/ i( (Z14/42
riP nt Name of Permit Ap
nt
Xr ‘-6 gefitr------ /X,'/2 6'. -
ignature of Per it Applicant Date
Permit#: tLC/1OV • OO6S2
Address: /J02/3 Su/ Jct/,r f,ticd 0,
Issued by: A1011l ,. Date: l 00. ,,i-
.t�l t ..
This Copy for Permit Offices