Permit Fri—I. CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2015-01006
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/28/2015
Parcel: 2S111 CA04400
Jurisdiction: Tigard
Site address: 9700 SW LAKESIDE DR
Project: Smith Subdivision: SUMMERFIELD NO.12 Lot: 664
Project Description: (1)branch circuit for patio cover.
Contractor: OWNER Owner: SMITH, KIRK H &CONNIE J
KIRK&CONNIE SMITH 9700 SW LAKESIDE DR
9700 SW LAKESIDE DR TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 503-639-7496 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 12/28/2015 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/28/2015 $6.74
Type of Use: SF Electrical
Class of Work: ALT 1 ea Investigation Fee 12/28/2015 $90.00
Type of Const:
1 ea Investigation 12%State 12/28/2015 $10.80
Surcharge
Occupancy Grp:
Total $163.72
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 regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001 010 through OA 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 1 32.19870 .B 332. 3st�t.
Issu d By: Permittee Signature: '\
OWNER INSTALLATION ONLY
The installation is being made on property I ch is not intende or sale,leas or rent. �t B
OWNER'S SIGNATURE Date: �p l�
CON' TOR 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 ApplicatioFOR OFFICE USE ONLY
City of Tigard ECEI V10Re
ED Dalei",e /S Permit t!: �l-C 5 Ol
a 13125 SW Hall Blvd.,Tigard,OR 97223 flan Relkiew
Phone: 503.718.2439 Fax: 503.598.19@)EC 2 8 2015 Date/By: Related Permitil:
Inspection Line: 503.639.4175 Ready Date/By: luris: ® See Page 2 for
Internet: www.tigai-d-oi-.gov CITY OF TIGARD
Notified/Method: I Supplemental Information
TYPE DIVISION1 PLAN REVIEW
❑New construction Addition/alteration/replacement Please check all that apply(submit 2 sets ofplans 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 lbr 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
❑Addition of new motor load of system.
Job#: Job site address: /�� /. w �y 1001-I11 or more. ❑"A "F-.-'1-2 -1-Y.
City/State/ZIP: / /� �t ❑Six or more residential units. occupancy.
(a7 llk✓ ,L as ❑health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt M Project na1n1C: r/' �,��- ❑1la-rardous locations. [I Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions tojob site: 9ri ��/ � FEE SCHEDULE
Descri pik I Q1N. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: ] Lot#: Includes attached garage.
1,000 sq.11.or less 16854 4
Tax map/parcel#:
Ea.add']500 sq.It.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
75.00 "
(with above sq.fl.)
Limited energy,multi-family 75,00 2
residential(with above sq.11.)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: ' ; 7XI 200 amps or less 100.70 2
Address: g 7�� �[���� 2 201 amps to 400 annps 13356 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 7n,4 �2 i? 601 amps to 1,000 amps 301.04 2
Phone: ) CA 5� ;% 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 mbTe on property that I own which is not 200 amps or less 59.36 I
intended for sale, Icr cxc4wigc, ding to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: _ Date:12 401 amps to 599 amps 168.54 2
❑ APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,pcr panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 �((�
branch circuit
City/State/ZIP: Each add']branch circuit 7.42 2
Miscellaneous(service or feeder not it
Phone:( ) Fax: :( ) Each manufactured or modular 67.84
(hvelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.54 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 2
Address: panel,alteration,or extension. ❑ Sec Page 2
City/State/ZIP: Each additional inspection over allovyable 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 Lic.: Electrical Lic.: Suprv. Lic.: specifically listed(V hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal:
Print name: Date: ❑Plan Review Required(25%ol'permit lee):
State surcharge(12%of permit fee): (p•7
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within ISO
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowe a pe tit.I /QD
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description QN�. 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
❑ 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
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Mach 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: Mach additional inspection is 66.25/hr I
charged at an hourh'(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(/:hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I):
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
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
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