Permit CITY OF TIGARD ELECTRICAL PERMIT
11111 I ' COMMUNITY DEVELOPMENT Permit#: ELC2015-00628
T IGAR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/10/2015
Parcel: 25111 DD08000
Jurisdiction: Tigard
Site address: 8617 SW AVON ST
Project: Vanderbuilt Subdivision: CHESSMAN DOWNS Lot: 6
Project Description: Panel replacement and(2)new circuits
Contractor: ROTH HEATING&COOLING Owner: VANDERBILT,AARON B
PO BOX 1265 8617 SW AVON ST
CANBY, OR 97013 TIGARD, OR 97224
PHONE: 503-266-1249 PHONE:
FAX: 503-266-3478
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 08/10/2015 $100.70
Specifics: amps or less
2 crt Branch Circuits w/Purchase 08/10/2015 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 08/10/2015 $13.86
Electrical
Type of Const:
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 accorda ith 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. ATTEN : Oregon law requ'es you to follow the rules adopted by the Oregon Utility Notification .Cen r. Those rules are set forth in OAR
952-001-00 thro h OAR 952- 01- 0. Y may obtain a copy of the rules or direct questions to OUNC by calling 503.23 19 or .800.332.2344.
Issue 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:
lCONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' \ Date: 1"/6/
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 Appli cat i FOR OFFICE USE ONLY
City of Tigard ��E��/ ® Received I- NW Penn"'
II
• 13125 SW Hall Blvd.,Tigard,OR 9722 y Plan Review f�a
R Phone: 503.718.2439 Fax: 503.598.1 a 1 0 2015 Date/By: Related Permit 5:
Inspection Line: 503.639.4175 Tv n O Ready Date/By: Juris: ® See Page 2 for
I It.AI.I, Internet: www.tigard-or.gov CITY i Oi' ; iGARD Notified/Method: Supplemental Information
r: il ''1i5 OPl
�1%PE O `t1'CJR1i t PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans wiitems checked):
❑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.
ind 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
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#:7c/ c 8 Job site address: t'1 Sin Rik n) Cr ❑Addition 0H moew motor load of system.
I I OOHP or more. ❑"A" "E" "1-2" "1-1°
City/State/ZIP: r n q ❑Six or more residential units. occupancy.
Tets�120 f V,_ 1 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0€1 IA L 1 ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: HA-U- ea-dP• FEE SCHEDULE
Description I (/r.• I Each I total I
New residential single-or multi-fancily dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential 75.00
/ -'r-� / ! (with above sq.ft.)
t✓E V la a-a Gk tyl f�►'P 1 - L( K� vim- `(V E ' Limited energy,multi-family 75.00
a_ ia.e..,, c 1 ate .4 s. residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less . ' 100.70 ,,f' .740 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 I
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 I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7'42 /�,��/ 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add')branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: I201-ei N'Lei/lti tNc- ' CcOLt d 0• Sign or outline lighting 67.84 2
Signal i or limited-energy Address: �q qo S n N (, . panel,al ter ation,or xennsion. ❑ See Page 2 2
City/State/ZIP: (e_, ' 3 Each additional inspection over allowable in any of the above
r M"Q `]V Additional inspection(1 hr min) 66.25/hr
Phone:603 )ate_ idyl Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(I hr min) 78.18/hr
Email: �j j ws 1 ` TN_I lc,.r. c'twt .
Inspections for which no fee is
CCB Lie.: /1/ev Electrical Lic/C .juFv"s Li c.:503 S specifically listed(Y2 hr mi ) 90.00/90.00/hr' ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required:
Subtotal: //j
Print name: Vt Jt f„} S pike SJt) I Date: S'— f,I5 ❑Plan Review Required(25%of permit fee): -
State surcharge(12%of permit fee): /3,
1 01 q
TOTAL PERMIT FEE:
Authorized signature: o
This permit application expires if a permit is not obtained within 180
Print name: I Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:BuildingPermits'ELC_PermitApp_ELR_ERE.doc Rev 06/172015 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
Description
Fee for all residential systems combined: $75.00 Each Total
Renewable Q ble electrical enera systems:
C heck Type of Work Involved: s kva or less I00.70
5.01 to 15 kva 133.56
fl 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
50.01 to 100 kva 552.26
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26
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:
❑ 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
speciticall■ listed 1'_hr mint
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system:ONLY:
$75.00 Subtotal(Enter on Page I):
(SEE OAR 918-309-0000) • Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
fl Boiler Controls
Clock Systems
Data Telecommunication Installation
I Fire Alarm Installation
[� HVAC
Instrumentation
I I Intercom and Paging Systems
n Landscape Irrigation Control*
Medical
7 Nurse Calls
Outdoor Landscape Lighting*
Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building,Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015