Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2015-00927
Date Issued: 11/19/2015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103DCO0807
Jurisdiction: Tigard
Site address: 13610 SW 115TH AVE
Project: Rivera Subdivision: VIRGINIA ACRES Lot: 5
Project Description: (3)branch circuits for interior remodel.
Contractor: OWNER Owner: RIVERA,AARON A&AMY N
AARON &AMY RIVERA 13610 SW 115TH AVE
13610 SW 115TH AVE TIGARD, OR 97223
TIGARD, OR 97223
PHONE:
PHONE: 503-888-0166
FAX
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 11/19/2015 571.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 11/19/2015 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 ATT • Ore..• law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-',410 through OAR 95 •• :'90. You may obtain a copy of the rules or direct questions to OUNC by calling 503. 87 o 1 Op.332 2344
Issu d By: � �.
y: . Permittee Signature: 111��
OWNER INSTALLATION ONLY
The installation is being made on prope I • w c.is tint ded for sale.lease or rent. /
OWNER'S SIGNATURE If �/ Date: ////9// S
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 1-Olt OFFICE 1 �I OvI
prilCity of Tigard �A Permit# L/� a�yr��q a7
° 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Related Permit n:
Phone: 503.718.2439 Fax: 503.598.1960 Date/B
T 1 G A RD Inspection Line: 503.639.4175 Ready Date/By: Juris id See Page 2 for
r, Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ®Addition/alteration/replacement 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.
CATEGORY OF CONSTRUCTION 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: El Fire pump. ❑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: 13610 SW 115t''Avenue IOOHP or more. ❑"A","E">"I-2","1-3
City/State/ZIP:Tigard,Oregon 97223 ❑Six or more residential units. ❑Recreational rea vehicle parks.
❑health-care facilities. P
Suite/bldg./apt.#: Project name:Recessed Lighting an ❑Hazardous locations. ❑Supply voltage for more than
El Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:Corner residence at 115th and Fairhaven FEE SCHEDULE
Description i Qty. Each I Total I '
New residential single-or multi-family dwelling unit.
Subdivision:Virginia Acres Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:2S103DC00807
La.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK limited energy,residential
/n�.� P 1 r, 1, ` (
(with above sq.ft.) 75.00 2
Q..Y(,QS�LC VICO 8011 UAe),2 k ( IC "Gto tin 1.6)�(]i �1�c 6 WO Limited energy,multi-family
y( �{//��// �� / o residential(with above sq.ft.) 75.00 2
Lti kst '^ YAiv� 1 (Y td`ry" i-vei, a'�"' l a.-0.0 '"' Z Renewable Energy El See Page 2
® PROPERTY OWNER 0 TENANT t
.5l4lAti al' I. Services or feed ers installation,alteration,and/or relocation
Name:Aaron Rivera 200 amps or less 100.70 2
Address: 13610 SW 115th Avenue 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,Oregon 97223 601 amps to 1.000 amps 301.04 2
Phone:(503)888-0166 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 1
intended for sale,le.: 1,ri i • ording to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: . ` t Date: 401 amps to 599 amps 168.54 2
1:3
APPLICA i 1=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:Aaron Rivera B.Fee for branch circuits without
Address: 13610 SW 115th Avenue service or feeder fee,first 1 56.18 56.11 2
branch circuit
City/State/ZIP:Tigard,Oregon 97223 Each add'I branch circuit R 7.42 14.ge( 2
Miscellaneous(service or feeder not included)
Phone:(503)888-0166 Fax: :( ) Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email:rivera.aaron.a@gmail.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: NA 0.1.4,r1J_Ein- Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. ® See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP:
Additional inspection(I hr min) 66.25/hr
Phone:( ) 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.: Electrical Lic.: Suprv.Lic.: specifically listed('/z hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 7/.D 2.
Print name: Date: ❑Plan Review Required(25%of permit fee): ..----.
State surcharge(12%of permit fee): f,��ItiM
Authorized signature: y TOTAL PERMIT FEE: 74,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\Permiis\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-461 5T(1 1/05/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
Fee for all residential systems stems combined: $75.00 Description Qty. even Tutal
� Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 10030 2
5.01to15kva 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:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
Fl G• arage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
Fl H• eating, 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: LED recessed lighting vj�,tt‘-erio,W15b/-1l.S , Each additional inspection is 66.25/hr 1
i charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(Y2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES .
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls •
F7 C• lock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ N• urse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ O• ther:
Total number of commercial systems: —
*No licenses are required. Licenses are required for all
other installations
P\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
'' 5 ` CITY OF TIGARD RECEIPT
{; g 13125 SW Hall Blvd.,Tigard OR 97223
,,,�;' 503.639.4171
Receipt Number: 400540 - 11/10/2015
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2015-00204 Plan Review 230-0000-43106 $97.34
Total: $97.34
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 1220 DHOWSE 11/10/2015 $97.34
Payor: Aaron Rivera
Total Payments: $97.34
Balance Due: $0.00
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