Permit CITY OF TIGARD ELECTRICAL PERMIT
114--- COMMUNITY DEVELOPMENT t Permit#: ELC2016 00588
TJIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 i•7 Date Issued: 07/25/2016
Parcel: 2S103 DA04300
Jurisdiction: Tigard
Site address: 10660 SW PARK ST
Project: Arreola Subdivision: FANTASY HILL Lot: 4
Project Description: (1)200 amp service replacement and(1)branch circuit.8/1/16,REPRINTED to add(1)additional branch circuit.
8/18/16,REPRINTED to change contractor from owner to Horton Electric.
Contractor: HORTON ELECTRIC Owner: ROSALES, LUIS ARREOLA
11266 SE 21ST AVE SUITE 107 ARREOLA,JESSICA
MILWAUKIE, OR 97222 10660 SW PARK ST
TIGARD, OR 97223
PHONE: 503-267-2797 PHONE: 503-890-8911
FAX: 503-659-8864
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 07/25/2016 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 07/25/2016 $12.08
Type of Use: SF Electrical
Class of Work: ALT 1 crt Branch Circuits w/Purchase 07/25/2016 $7.42
Service or Feeder
Type of Const: 0 ea 12%State Surcharge- 07/25/2016 $0.89
Occupancy Grp: Electrical
45 Misc Administration Fee 08/01/2016 $45.00
0 ea 12%State Surcharge- 08/01/2016 $1.79
Electrical
1 crt Branch Circuits w/Purchase 08/01/2016 $7.42
Service or Feeder
0 ea 12%State Surcharge- 08/01/2016 $-0.90
Electrical
45 Misc Administration Fee 08/18/2016 $45.00
Total $219.40
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, ATTE' . _ -.on law -quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001.$110 through OAR ",- 001-0$•$ You may obtain a copy of the rules or direct questions to OUNC by calling 50 232.1987 or 1.800.3 2.2344.
41
Iss'ed By: /�� J Permittee Signature: /W �o -
i
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' 4— �} `G�` Date: /f//c
LICENSE NO. 4z419 7 '3
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 on i i is l sl:O\I.ti
.., Y ¢
City of Tigard �t; ' i' ., a xis Received e��//0 0 5-O g
= Permit#:
Date/B
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Related Permit#:
Phone: 503.718.2439 Fax: 503.598.1960 Date/B :
Inspection Line: 503.639.4175 A i,1 R I_ 8 ?fl 16 Ready Date/By: Juris: la See Page 2 for
1 1 G A R D Internet: www.tigard-or.govNotified/Method: Supplemental Information
TYPE > IIG RU PLAN REVIEW
❑New construction 0 Additi�tr ,. Please check all that apply(submit 2 sets of plans w/items checked):
t.' c , s .'FtJ'; 0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps forallother installations. buildings.
❑Multi-family 0 Master builder ❑Other:
❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: /j.)4,&Q PA-rig .,t— 0 Addition of new motor load of system.
100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: ❑Six or more residential units. occupancy.
0 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'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
''11 _ �^t Q ,� Q I b (with above sq.ft.)
l Fi (�tO /�T"—' ' C'�U 2' r� /CCQ 2 l 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: A K._k_o Llr 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:
601 amps to 1,000 amps 301.04 2
Phone:( ) 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,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
0 APPLICANT 0 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: 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: f I., N E c_T K_C C Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: l t 2...(0‘, Se- Ziff'jil e-- 10-7 panel,alteration,or extension. 0 See Page 2 2
1 Each additional inspection over allowable in any of the above
City/State/ZIP: 14 l L 1JA-('Ki El o /2._ 2 17 Z2 Additional inspection(1 hr min) 66.25/hr
Phone: 3) L —t 4 %,g Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: hof'.10 tv.—. ay Q.Q
U v "� L l :CD AA Inspections for which no fee is 90.00/hr
8.
r l
CCB Lic.: .I 3 Electrica/ Date:
L. Suprv.Lic.: -5 specifically listed('A hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: / Subtotal:
Print name: ‘7,41 tz �/` / 0 Plan Review Required(25%of permit fee):
NN State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
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\ELCPermitApp_ELR ERE.doc Rev 06/17/2015 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 Qty. I Each I 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
n Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
n Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
n 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('h hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT y) )4
Subtotal Enteron Page 1):
Fee for each commercial system: $75.00
y * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n D• ata Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n L• andscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n O• ther:
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
•
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMEtryl,
'PiRequest for Permitw
q Action z;,
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • ard�-lr� p
TO: CITY OF TIGARD x,i��.;��� j
Building Division "h° ,/ $
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ► Owner ❑ Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name: /V/�
INVOICE TO: (Business or Individual)
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑ CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
g REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: E LC a--O ! (0,—* OO 5$q
Site Address or Parcel#:
Subdivision Name: Lot#:
EXPLANATION: �`�,,,,,,,,,o, " ,pe,,r m`---- --- (c_n_ -n,-.-(-Dy-
Signature: >���_ Date: / // (Ci
Print Name: i.�S)cek ,
; -. ;o3ic
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
Route to Sys Admin: Date if a g /4 Route to Records: _ Date By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_092314.doc
CITY OF TIGARD ELECTRICAL PERMIT
91 1 ' COMMUNITY DEVELOPMENT I I Permit#: ELC2016-00588
FGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/25/2016
Parcel: 2S103DA04300
Jurisdiction: Tigard
Site address: 10660 SW PARK ST
Project: Arreola Subdivision: FANTASY HILL Lot: 4
Project Description: (1)200 amp service replacement and(1)branch circuit.8/1/16,REPRINTED to add(1)additional branch circuit.
Contractor: OWNER Owner: ROSALES, LUIS ARREOLA
LUIS AND JESSICA ARREOLA ARREOLA, JESSICA
10660 SW PARK ST 10660 SW PARK ST
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503-890-8911 PHONE: 503-890-8911
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 07/25/2016 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 07/25/2016 $12.08
Type of Use: SF Electrical
Class of Work: ALT 1 crt Branch Circuits w/Purchase 07/25/2016 $7.42
Service or Feeder
Type of Const: 0 ea 12%State Surcharge- 07/25/2016 $0.89
Occupancy Grp: Electrical
45 Misc Administration Fee 08/01/2016 $45.00
0 ea 12%State Surcharge- 08/01/2016 $1.79
Electrical
1 crt Branch Circuits w/Purchase 08/01/2016 $7.42
Service or Feeder
0 ea 12%State Surcharge- 08/01/2016 $-0.90
Electrical
Total $174.40
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 acc 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 ION: Orego law requires you to follow the rules adopted by the Oregon Utility Notificati•• enter. Those rules are set forth in OAR
952-001-00 0 through OAR 952- 01 %$90.1/ • may obtain a copy of the rules or direct questions to OUNC by - -,. .1987 or 1.800.n2.2344.
Issued \ �1 Permittee Signatu11111111111r ii _ d-1(
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 Applicatio> ( , » - l O R o h r l c u. ( Si:0\1,1
City of Tigard Received Q
13125 SW Hall Blvd.,Tigard,OR 97223 / u 2 1 Date/B : u , Permit#: f(0_�Q s g
Plan Review
Phone: 503.718.2439 Fax: 503.598,1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175 ..f i f ReadyDate/By: Juris:
-I IGARDSeePage2for
Internet: www.tigard-or.gov ,,: Notified/Method: Supplemental Information
r
TYPE OF WORK PLAN REVIEW
0 New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other: 0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 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.
0 Multi-family 0 Master builder 0 Other:
El Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
f c ❑Addition of new motor load of system.
Job#: Job site address:
(D(Q' o -t,) Pfril/. 6--r. 100HP or more. ❑«A» ..E„ «1.2» ..1 3„
City/State/ZIP: ❑Six or more residential units. occupancy.
0 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
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
�t) ( /► (with above sq.ft.) 75.00 2
�''�C `-� "' Limited energy,multi-family
75.00 2
0 j 10—UO CS3. residential(with above sq.ft.)
❑ PROPERTY OWNER Renewable Energy 0 See Page 2
❑ TENANT` Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Email:
Temporary services or feeders installation,alteration,and/or
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,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
Branch circuits–new,alteration,or extension,per panel
0 APPLICANT ❑ CONTACT PERSON
A.Fee for branch circuits with
Business name: 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 7.i/,- 2
branch circuit
City/State/ZIP: Each add'l branch circuit 4_ 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
Email:
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: t )' /< C Sign or outline lighting 67.84 2
Address: C Signal circuit(s)or limited-energy
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 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed('/z hr min)
ELECTRICAL PERMIT FEES -7.41:01-
Suprv.Electrician signature,required: Subtotal: ! '
Print name: Date:
State surcharge(12%of permit fee): 'J� ' • gq
Authorized si atur • �+ TOTAL PERMIT FEE: f�!� �� / This permit application expires if a permit is not obtained within 180
Print name: (.7/,,,,i,e4,<,/Y/
v Date: .-76... i J / to. days after it has been accepted as complete.
* Number of inspections allowed per permit. 453. 3/
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 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 I Qty. I Each I Total
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:
n Burglar 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
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:
❑ 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('/2 hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL 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
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
Fl Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ 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 PermitApp_ELR_ERE.doc Rev 06/17/2015
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT
Permit#: ELC2016-00588
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/25/2016
Z EC®a�k. 9
Parcel: 2S103DA04300
Jurisdiction: Tigard
Site address: 10660 SW PARK ST
Project: Arreola Subdivision: FANTASY HILL Lot: 4
Project Description: (1)200 amp service replacement and(1)branch circuit.
Contractor: OWNER Owner: ROSALES, LUIS ARREOLA
LUIS AND JESSICA ARREOLA ARREOLA,JESSICA
10660 SW PARK ST 10660 SW PARK ST
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503-890-8911 PHONE: 503-890-8911
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 07/25/2016 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 07/25/2016 $12.08
Type of Use: SF Electrical
Class of Work: ALT 1 crt Branch Circuits w/Purchase 07/25/2016 $7.42
Service or Feeder
Type of Const: 0 ea 12%State Surcharge- 07/25/2016 $0.89
Occupancy Grp: Electrical
Total $121.09
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 ma obtain a coppof the rules or direct questions to OUNC by calling 50 .4987 or 1.800.332.2
Issued By: ‘L.,44Permittee 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 ,, ., Foi orrice: t sl.0\I.\
illCity of Tigard
'" Received
Date/B i jlI i� i +
u 13125 SW Hall Blvd.,Tigard,OR 97223 y Plan Review
' C Phone: 503.718.2439 Fax: 503.598.1960 ;'t.1 1 b Date/B : Related Permit#: t�_
Inspection Line: 503.639.4175 it 1 s4 z.1 , .a' Ready Date/By: ® See Page 2 for
T I G A R D Internet: www.tigard-or.gov '>Notified/Method: IMO Supplemental Information
_.
TYPE OF WORK .,w wtiI,1135,1{0N PLAN REVIEW
❑New construction Addition/alteratiotilrepiacetnent 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 Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
,1:11-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
ampngs.
0 Multi-family 0 Master builder 0 Other: Fire form all other installations. bu
0Fire pump. Installation❑ of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
'r�C q� ` ❑Addition of new motor load of system.
Job#: Job site address:
` D(W S j Par IC 1--, 100HP or more. ❑«A» "E,> «l 2„ «I 3„
❑Six or more residential units. occupancy.
City/State/ZIP: 'l ,(- V_ G� 0Recreational vehicle parks.
J t ��
0 Health-care facilities.
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: 1)(kr V 5-k-- ) . (4±-- R FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
r7,•�, (with above sq.ft.)
2C-�% C\l/1\ Seib V I Ve CI,1 ck_r‘ -4.--E -- Limited energy,multi-family 75.00 2
1- a_ 1 < \f( NACA.1 c` c-c L- -V residential(with above sq.ft.)
PROPERTY OWNER Renewable Energy 0 See Page 2
❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: ^ 200 amps or less 100.70 1 2
Address: SC.Ortfu
201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:(95 ) 'CC a eG(kk Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: er r---t C\a 1 ct Vc, 0.i h o- y\a( k Jon') relocation
Owner installation:This installation is bein ade on property that I own which is not 200 amps or less 59.36 1
intended for sale,lea ,'tent,or exchan ,acco ding t• •RS 44 449,670, . d 701. 201 amps to 400 amps 125.08 2
Owner signature. /7 , if , '4 . Date:. ' .- 401 amps to 599 amps 168.54 2
ICANT CONTACT P' 'SO Branch circuits-c new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, I 7.42 j ti)--- 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'I 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: Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
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
Industrial plant(1 hr min) 78.18/hr
Email:
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: /( ,/)'
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): f .q 7
Authorized signature: TOTAL PERMIT FEE: i+ 1, X)(1
" J� This permit application expires if a permit is not obtained within 180
Print name: ' `j l � K l .lei Date: Z j ,, days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building0'ermits\EL ermitApp_ELR_ERE.do Rev 06`/1 5 0-061 (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 I Qty. I Each I 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
n 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(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/hr min)
COMMERCIAL WORK ONLY:
'ELECTRICAL PERMIT on FES=.
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 D• ata Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
n L• andscape Irrigation Control*
❑ M• edical
❑ 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
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015