Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit#: ELC2015-00846
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/19/2015
Parcel: 1 S 136DD07601
Jurisdiction: Tigard
Site address: 11905 SW 69TH AVE
Project: Nadri Subdivision: WEST PORTLAND HEIGHTS Lot: 36
Project Description: Reconnect only
Contractor: OWNER Owner:
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 10/19/2015 $67.84
Specifics:
1 ea 12%State Surcharge- 10/19/2015 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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
952-001-0010 through OAR 952-001-0090. You m btain a copy of the rules or direct questions to OUNC by calling 503.23 .1 7 or 1.800.332.234 .
r
Issued 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:
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 Folz of l l(l: i, si 0111
City of Tigard t:te/B : 10 l9 ennit#:
IIII
• 13125 SW Hall Blvd.,Tigard,OR 97223 RECEIVE ` ', 1
• Phone: 503.718.2439 Fax: 503.598.1960 Related Permit#:M' 120 man
11
Inspection Line: 503.639.4175
OCT 19 2015 Ready Date/By: H See Page 2 for
1 I G n R D Internet: www.tigard-or.gov Notified/Method: IMMI Supplemental Information
TYPE OF WORK CITY OF TIGA�RD PLAN REVIEW
❑New construction ❑ ddition/alteratio®IJG DI ISION Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition Other: np� 'Y ❑Service or feeder 400 amps or more ❑Building over three stories.
v C t ,•`( where the available fault current ❑Marinas and boatyards.
CATE ORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
54 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: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: I Job site address: //905- 5,L1.1 r �9 1h �V e ❑Addition of new motor load of system.
IOOHP or more. ❑"A",`E "I-2","1-3",
City/State/ZIP:(-77.1 A_2 d '7722 ❑Six or more residential units. occupancy.
O Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: ['Project name: VIA D rat ❑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 I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'[500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(with above sq.ft.)
Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
PROPERTY OWNER
Renewable Energy ❑ See Page 2
0 J Services or feeders installation,alteration,and/or relocation
Name:40 s a L L c ( kA 2E M t"C.N A',A(�2r4._v,\.s A qt1F 200 amps or less 100.70 2
Address: /5/0 6 •fh !,]Bret�' 201 amps to 400 amps 133.56 2
) { 1706 0 401 amps to 600 amps 200.34 2
City/State/ZIP: (J,e51t LI Nn/� V r? 6 601 amps to 1,000 amps 301.04 2
Phone:(56;) 711_345 ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: ke1,'n/Mri ( _( vv.t:c-t.g,Ca k'" relocation
Owner installation:This in tallation is being mad n property that i own which is not 200 amps or less 59.36 1
intended for sale,lease e ,or exchange,a o mg to ORS 447,449,670,/y /5 nd 701. 201 amps to 400 amps 125.08 2
Owner signature: Date:
f d 401 amps to 599 amps 168.54 2
❑ PLICANT 1 ❑ CONTACT P RSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: J�u,...ii_ q 5 of wv.i, 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'l branch circuit 7.42
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 1 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 '
Business name: L 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(I hr min) 66.25/hr
Phone:( ) I Fax:( ) Investigation(I hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: I Electrical Lie.: I Suprv. Lie.: specifically listed('/hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required:
Subtotal: 41,SE (
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 95-, tli
TOTAL PERMIT FEE:
Authorized signature: S�
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.
I:Building Permits,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 Qtv. I Each j Total I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 1 00.70 2
5.01 to 15 kva 133.56 2
n A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n B• urglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
n Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ 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:
n Other: Each additional inspection is 66.25/hr I
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
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:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:'Building PermitsELC_PermitApp_ELR_ERE.doc Rev 06.172015