Permit y CITY OF TIGARD ELECTRICAL PERMIT
•
1 '''' COMMUNITY DEVELOPMENT Permit#: ELC2016-00544
T1GRD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/06/2016
A
Parcel: 2S112CD02000
Jurisdiction: Tigard
Site address: 15630 SW 79TH AVE
Project: LAYTON Subdivision: DURHAM ACRES Lot: 14
Project Description: Temporary power.
Contractor: OWNER Owner: LAYTON, RONALD J
RONALD LAYTON 15630 SW 79TH AVE
15630 SW 79TH AVE TIGARD, OR 97224
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
Specifics: 1 ea Temp Services or Feeders- 07/06/2016 $59.36
200 amps or less
1 ea 12%State Surcharge- 07/06/2016 $7.12
Type of Use: SF Electrical
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $66.48
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 - k will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuanc- , if work is suspended f •••r> the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification ent- . Those rul>- are •1fo' in OAR
952-001-0010 through OAR 952-001-0090. You ma copy of irect questions to OUNC by calling 50 32.19- or 1.800.332. •4
Issued By: jG ! .----- Pe mittee Signature: `APP ...'/
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 / FOR OFFICE t SE OyI.I
City of Tigard ,� �.Z Received
111 13125 SW Hall Blvd.,Tigard OR Q2`l Date/B : ' ESI ;,��
Plan Review
Phone: 503.718.2439 Fax: 503 598 160 Date/B : Related Permit#:- r
Inspection Line: 503.639.4175 •-_ ) 1 h Ready Date/By: Juris: H See Page 2 for
1 I L n K D Internet: www.ti and-or. ov °¢ 1 Notified Method:
g g Supplemental Information
i Nap
TYPE OF WORK .. �;116, PLAN REVIEW
❑New construction [Addition/alterlttion/replacement 'ter Please check all that apply(submit 2 sets of plans w/items checked):
• 0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other:
where the available fault current 1 -` 0 Marinas and boatyards.
CATEGORY OF Cd1��hyg�'I'RUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
S C�30 S 7� ��Gi.4 ID Addition of new motor load of system.
Job#: Job site address: 100loollP or more. ❑"A",``E","1-2",°`1-3",
City/State/ZIP: 77 6 A--i-2_, 3-2L 5 2 2-2-7 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 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: Lot#: Includes attached garage.
Tax map/parcel#:
1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: p p/N.1 L:0 / 200 amps or less 100.70 2
Address: i_�3 p 5 L„) 7 Cl ,, -
201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 7?6/17-2,e9 / ,...)/L. > ZZ 601 amps to 1,000 amps 30L04 2
Phone:(9'b 4i) 5—e..- . S Fax:( ) Over 1,000 amps or volts 552.26 2
/ Temporary services or feeders installation,alteration,and/or
Email: 0 , (r7 7 y 3( `0 ,L relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less / 59.36 517,;Ii/ 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
11
APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business nam4: D L,,,g � above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first
Address: branch circuit 56.18 2
City/State/ZIP: Each add'l 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: B L.-f j-.0...4_, Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed('A hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: ),j J/ 61Vrn_ Date: 6/4.c/‘. 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: 11Le‘
This permit application expires if apermit is not obtain
PP p ed within 180
Print name: ���� /�j Date: days after it has been accepted as complete.
.�// * Number of inspections allowed per permit.
I:\Building\Permrts PermitApp_ELR_ERE.do ev 06/17 015 440-4615T(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 1 Qty. Each I Total 1
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
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
552.26 2
with OAR 918-309-0040)
❑ 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 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/s hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONLY: 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
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015