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Permit CITY OF TIGARD ELECTRICAL PERMIT I - COMMUNITY DEVELOPMENT Permit#: ELC2015-00660 Date Issued: 08/19/2015 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135DC07800 Jurisdiction: Tigard Site address: 11675 SW 90TH AVE Project: WINTER Subdivision: TIGARDVILLE PARK Lot: 7 Project Description: Panel replacement. Contractor: OWNER Owner: WINTER, ELI RAVEN RAVEN WINTER 12595 SW BROOKSIDE AVE 11675 SW 90TH AVE TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503-809-7643 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders-200 08/19/2015 $100.70 Specifics: amps or less 1 ea 12%State Surcharge- 08/19/2015 $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 • • .-• • .ct to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be do in accordance with -••roved plans. This permit will expire if work is not started within 180 days of issuance, or ' ork is suspended for more the 180 day-. ATTENTION: Oregon la re• - 'tau to follow the rules adopted by the Oregon Utility Notification Can Those rules are in OAR 95 -001-0010 thr ugh OAR 952-00 .•90. You a obtain a copy of the r as or direct:: :::° e " 232 ti OUNC by or 1.800.332 44. ssued By: / : OW ER INSTALLATION ONLY The installation is being made on property I 5,011",. - / y/� J OWNER'S SIGNATURE /�� Date: 0 /� / CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' • 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 r INNI) Date/Byy: g J 9/t s /9 ij— Permit#: k_i-c- of ex1G(en i 2 a 13125 SW Hall Blvd.,Tigard,OR 1 t Plan Review Phone: 503.718.2439 Fax: 503.5' ' �.+ 1� Date/By: Related Permit n: Inspection Line: 503.639.4175 .° '1 Ready Date/By: Juris: El Sec Page 2 for TIGARD Internet: www.tigard-or.gov ��\� 49 Notified/Method: Supplemental Information TYPE OF WORK U OV �(�}[` % PLAN REVIEW ❑ New construction Addition/alteratioesN P>�fllt�j4', Please check all that apply(submit 2 sets of plans w/items checked): l v ['Service or feeder 400,amps or more ❑Building over three stories. ❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONS T77ON exceeds 10.000 amps at 150 volts or ❑Floating buildings. El I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑ Multi-family ❑ Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: t 16 2c s © ' 100HP or more. ❑°A"."E"."l-z","t-3", City/State/ZIP: / 647 ❑Six or more residential units. occupancy. �` I v_ �� ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: I Project name: ❑Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description 1 Qty. I Each 1 lolal I New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.R.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential K eLt.e.....e_ - (with above sq.ft.) 75.00 2 i�,2� 041 P� Limited energy,multi-family 2 residential(with above sq.ft.) 75.00 Renewable Energy ❑ See Page 2 ❑ PROPERTY OWNER I ❑ TENANT . Services or feeders installation,alteration,and/or relocation Name: l�ifn LA) .y∎$_.xi 200 amps or less / 100.70 / 7v 2 201 amps to 400 amps 133.56 Address: 12yr, �� ty7� Ai_4_ 2 401 amps to 600 amps 200.34 2 City/State/ZIP: O' 2__'Z3 601 amps to 1,000 amps 301.04 2 Phone:( 0 J) Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: ra,I� a,1 , C9""^ relocation Owner installatx t�lation is b ing ade on property that I own which is not 200 amps or less 59.36 1 intended for sale ,ore han to ORS 447,449,670 1 and 01. 201 amps to 400 amps 125.08 2 Owner signature � _Date: ! 401 amps to 599 amps 168.54 2 In 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, 2 7 42 M each branch circuit Contact name: i3 v,n' B.Fee for branch circuits without Address: / /. service or feeder fee,first 56.18 _ I� Sl5' S'U 1 , _ ,',4 branch circuit City/State/ZIP: Cr) r 0) /- Gl'2 7Z Each add'I branch circuit 7.42 Miscellaneous(service or feeder not included' _ Phone:( � ��' � Fax: :( ) Each manufactured or modular 67.84 2 /'-� � dwelling,service and/or feeder Email: l �✓ t 0 Reconnect only 67.84 2 00,,,,EL: NT RACTOR Pump or irrigation circle 67.84 - Business name: NA _ /5��_,/ Sign or outline lighting 67.84 2 t v Signal circuit(s)or limited-energy ❑ See Page 2 Address: panel,alteration,or extension. ` City/5tate/ZIP: Each additional inspection over allowable in any of the above Additional inspection(I hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(I hr min) 90.00/hr Email: Industrial plant(I hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lie.: I Electrical Lic.: Suprv.Lie.: specifically listed(v hr mint ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: i0i), -kJ Print name: I Date: ❑Plan Review Required(25%of permit fee): — State surcharge(12%of permit fee): s'i,.08 Authorized signa r-� : TOTAL PERMIT FEE: //),"d G This permit application expires If a permit is not obtained within 180 Print name: / I Date: )/ �f dais after it has been accepted as complete. * Number of inspections allowed per permit. I.Budding Permits'EL _PerrnitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T( 1 5/COM1WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Description I Qty. f Each I Total Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 2 Check Type of Work Involved: 5 kva or less 100.70 5.01 to 15 kva 133.56 2 ( I 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 ❑ Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 U 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: CI Other: Each additional inspection is charged at an hourly(1 hr min) 66.25/hr 1 Inspections for which no fee is 90.00/hr specifically.listed('V hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal on Page 1): * Number of inspections allowed per r perm permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems n Boiler Controls Clock Systems Data Telecommunication Installation Fire Alarm Installation n HVAC Instrumentation n Intercom and Paging Systems Landscape Irrigation Control* I I Medical Nurse Calls n 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_PermilApp_ELR—ERE.doc Rev 06 17 2015