Permit n CITY OF TIGARD ELECTRICAL PERMIT
I'! 1 , COMMUNITY DEVELOPMENT Permit#: ELC2014-00376
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/10/2014
Parcel: 2S109DA15500
Jurisdiction: Tigard
Site address: 15298 SW GREENRIDGE PL
Project: HAGGERTY Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 74
Project Description: Electrical for solar photovoltaic system
Contractor: ELECTRIC WORKS INC Owner: HAGGERTY, KELLY P&JACKIE
9122 SE 67TH AVE 15298 SW GREENRIDGE PL
PORTLAND, OR 97206 TIGARD, OR 97223
PHONE: 503-774-6444 PHONE:
FAX: 503-775-6541
FEES
Quantity Description Date Amount
1 ea 5 kva or less 07/10/2014 $100.70
Specifics:,
1 ea 12%State Surcharge- 07/10/2014 $12.08
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 accord.. - • 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. ATTENTI' : Oregon la• re. .res you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 rou�R 952-00 •r r Y/ may obtain a copy of the rules or direct questions to OUNC by calling 503.2 .19 7 or 1.800.332.2344.
Issued By: 6 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 I STALLATION ONLY
SIGNATURE OF SUPR.ELEC' - - " - , .9rrf"7 L4.2-/ U Date: 7//e)//V
LICENSE NO. - 5c"/C)
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 RECEIVE FOR OFFICE USE ONLY
City of Tigard Received
III Date/By: 7 /D /4/ ,,,4_,;.,,,,, Permit No.: iK ACX, )376
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ,/
• Phone: 503.718.2439 Fax: 503.598.1960 JUL 1 0 20 14 Date/By: Other Permit: N ( 45Q`05.-
I I t, 1:1 Inspection Line: 503.639.4175 Date Ready/By: kris 65 See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF W VISION PLAN REVIEW
!�`t �� Please check all that apply(submit 2 sets of plans w/items checked below):
12 New construction ®Addition/altera to r iNi replacement
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
IR 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building 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 system.
❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: 5333 Job sitc address: 52.41B &.) &r r: ` Six or or more. occupancy.
N ?kcal. ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: 1-:6,0,rU O ro ij s---.1 ❑Health-care za do facilities.
❑Supply voltage for more than
1 J I ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description
1 Qtv. I Fee. 1 Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy _ )(See Page 2
Services or feeders installation,alter and/or relocation
®, PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 1.Q\\,i \4 �,Ft, 401 amps to 600 amps 200.34 2
Address: C t7 2A� SW UcG.![_f1(vet) cA 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: 'T i v rc F O& cn 2'LLA Temporary services or feeders installation,alteration,and/or
Phone:(S03) C,'Lck 34 3-- relocation Fax:( ) 200 amps or less 59.36 I
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps[0 599 amps 168.54 2
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
❑ APPLICANT CI,CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
Business name: E1 as: {1c. W0C VA, '_,^C each branch circuit 7.42 2
C B.Fee for branch circuits without
Contact name: A,I,ttt\60A ( O service or feeder fee,first
branch circuit 56.18 2
Address: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Phone:(11) 1 S o`O e n(o Fax::( 503) 17 5 - 65 k
Reconnect only 67.84 2
E-mail: 4,44GrAt Q,6,,,;t- Q ooX . Cz vy Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: a�.1t(; , wo`�S Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: G`2.-e- S. . (:).--(-61 j\‘)41. Each additional inspection over allowable in any of the above
City/State/ZIP: or}\Qr0� ' O Q 41�O` Additional inspection(1 hr min) 66.25/hr
f� "1 v Investigation(1 hr min) 66.25/hr
Phone:(9p'3) -7"1 t.l _;444 1,1a Fax:(503) - 7 5_ ,,E1.4 t, Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: L 815. Electrical Lie.:26.454 , Suprv. Lie.: S• y0 S specifically listed('/:hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: C LrxuciS Subtotal: /6)6. 7d
�M Plan review(25%of permit fee):
Print name: ■a Tray Lo rata S Date: 1 _\b_W�
J State surcharge(12%of permit fee): /.2-..eig
Authorized signature: TOTAL PERMIT FEE: //9-- 7t3
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.
L\Building\Perm its`ELC_PermitApp_ELR_ERE.doc Rev 05'21'2013 440-46151(11/05/COtstWEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined $75.00 Description I Qty. I Fee I Total I •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less y 100.70 100 70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
ElAlarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
OAR 918-309-0040)
Heating, Ventilation and Air Conditioning -
System* Solar generation systems in excess of 25 kva:
Each additional kva over25 7.42 3
n Vacuum Systems* >100 kva—no additional charge 0.0 3
n Other: Each additional inspection over allowable in any of the above:
Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(A hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal: top 10
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee): 11,D r1
Check Type of Work Involved: TOTAL PERMIT FEE: 1\1„ 1q
This permit application expires if a permit is not obtained within 180
Audio and Stereo Systems days after it has been accepted as complete.
* Number of inspections allowed per permit.
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
I� HVAC
❑ Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
I I Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\BuildingTermits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013