Permit CITY OF TIGARD ELECTRICAL PERMIT
°111111 Permit#: ELC2015-00405
COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/27/2015
T iUl#RI� Parcel: 25111 DD09400
Jurisdiction: Tigard
Site address: 15955 SW 87TH AVE
Project: Kelly Subdivision: CHESSMAN DOWNS Lot: 20
Project Description: Upgrade existing panel to 200 amps
Contractor: OWNER Owner: KELLY, JASON R
JASON KELLY 15955 SW 87TH AVE
15955 SW 87TH AVE TIGARD, OR 97224
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 05/27/2015 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 05/27/2015 $12.08
Type of Use: SF Electrical
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 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 requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-00 • rough•-' 95 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 r 1.800.332.2344.
I -4/
Issue By: • i' Permittee Signature:
/4K--
OWNER INSTALLATION ONLY
The installation is being made on property I ow hich is not intended for sale,lease or rent.
OWNER'S SIGNATURE rte, Date: 7/5!
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELES' 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 Applicatip> p FOR OFFICE LSE ONLY
City of Tigard �_ , 'i Received 5�� Le / .j'z C D�
i . •5 f g Dete/B / Permit k: G
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.591>).1%0.) :A Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: 'uric EI See Page 2 for
T I G A It l) Internet: www.tigard-or.gov Notified/Method: Supplemental Information
❑New construction ❑Addition/alteration/t•-a 1aCemdltt'' Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
exceeds 10,000 amps at 150 volts or ❑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.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
❑Emergency system, larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: (S "1 ,s St,J Z)-7"1?' 1 OOHP or more. ❑"A","E","1-2","1-3°,
City/State/ZIP:/State/ZIP: ��2 ❑Six or more residential units. occupancy.
ty �tG�2 �-2�( ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: Fi.ANi L U t C. £ ❑Hazardous locations. ❑Supply voltage for more than
e;
El Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: •.; . .
Description Qty. Each Total •
New residential single-or multi-family dwelling unit.
Subdivision: I 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
Limited energy,residential 75.00 2
UPCizA Q£ 6� ( Tt/Jr °U P >EL1lc-cM (wedenevesq.ft.)
7 M1. Limited energy,multi-family •
` P residential(with above sq.ft.) 75.00 2
p41J—� �o lQ�A.�n a ,�
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name: 3 A S c t- KC 1.,1,1 200 amps or less j 100.70 /40 70 2
Address: S J c StA Y571" dy e 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: I/y 0 20 / 02 '17 1 Z. 601 amps to 1,000 amps 301.04 , 2
Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This in tallation is being made on property that I own which is not 200 amps or less 59.36 I
intended for sale,lease,re ,or ex hange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: S' 2 7-1 r 401 amps to 599 amps 168.54 2
Branch circuits—new,alteration,or extension, er panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
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
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Business name: i eye..., Sign or outline lighting 67.84 2
Address: panel,alteration,oextension.limited-energy or ❑ See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP:
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 66.25/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed %hrmin
Suprv.Electrician signature,required: Subtotal: e 2, 76
Print name: Date: ❑Plan Review Required(25%of permit fee): —Q
State surcharge(12%of permit fee): la.C'q
Authorized signature: TOTAL PERMIT FEE: /,( , 7g
This permit application expires if a permit is not obtained within 180
Print name: f 0. L L Lt) Date: S 217_ r✓ days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permit s\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 440-4615T(I1/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDUL
Description I Qty. Each Total •
Fee 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
El Audio 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
El Garage Door Opener*
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
El Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
El Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
El Other: 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
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
• Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El 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 04/21/2014