Permit CITY OF TIGARD ELECTRICAL PERMIT
1 ' COMMUNITY DEVELOPMENT741
Permit#: ELC2016 00762
RD13125 SW Hall Blvd.,Ti and OR 97223 503.718.2439 Date Issued: 10/05/2016
'` g Parcel: 2S111DC00700
Jurisdiction: Tigard
Site address: 15780 SW ALDERBROOK CIR
Project: Billups Subdivision: SUMMERFIELD NO.8 Lot: 454
Project Description: Replace service panel
Contractor: APOLLO ELECTRIC LLC Owner: PATRICIA BILLUPS
PO BOX 80783 15780 SW ALDERBROOK CIRCLE
PORTLAND, OR 97280 TIGARD, OR 97224
PHONE: 503-421-1691 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 10/05/2016 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 10/05/2016 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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. ATTENTI N' Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are seVforth in OAR
952-001-00 hrough OA' 95 .. -Z09• You may obtain a copy of the rules or direct questions to OUNC by calling 503.232. or 1 '00.33 234:;',A' /`
Issued By: ' _ 'illi I.� / Permittee Signature: /4
OWNER INSTALLATION ONLY r
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' / i - Date: /624-7// c3,
LICENSE NO. yf 9 s
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 lsi OyLI
City of Tigard Date/B d b A/L"Imul Permit#: 0,.....e....(90/d2-00 69 7-
71 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Juris: H See Page 2 for
T I G A R D Internet: www.tigard-or.gov Notified/Method: Supplemental Information
�J'YPE OF WORK PLAN REVIEW
❑New construction ., I nu dition/alteration/replacement 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.
.011 .(i-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
am❑Multi-family ❑Master builder 0 Other:
0 Fire Fire for all other installations. buildings.
pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION + Q 0 Emergency system. larger separately derived
Job#: Job site address: I c O at �^� ei-ag t h-`�>^+❑Addition of new motor load of system.
t
, 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: 'C r� V� ❑Six or more residential units. occupancy.
0 Health-care facilities.
0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Di`/SPS 0 Hazardous locations. 0 Supply voltage for more than
0 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.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF W RK Limited energy,residential 75.00 2
{��p� A� j�� „� /��yi/3�g (with enersq.gy,
multi-family
lace plow` / A r(-GJ 1. Limited energy,multi-family
(' residential(with above sq.ft.) 75.00 2
❑ PROPERTY O R " 0 I ENAIVT Renewable Energy ❑ See Page 2
Services or feeders installation,al{era jion,and/or relocation
Name: t . 200 amps or less )( 100.70 2
r L� �rr�� 201 amps to 400 amps /` 133.56 2
Address:
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 signs re: Date: 401 amps to 599 amps 168.54 2
PLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: A jr)))6 &10C111-1 above service or feeder fee,
7A2 2
each branch circuit
Contact name: f ')C le J'},�t y B.Fee for branch circuits without
Address: �r`G s � rC 11' ,i service or feeder fee,first 56.18 2
G/ e_ branch circuit
City/State/ZIP: Pit i' y)de_ Q Z7 Each add'l branch circuit 7.42 2
Phone: G' � / Miscellaneous(service or feeder not included)
( .I /C:.qFax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: h Ce,, 4 p b j% e4C J—y i e i ( � l ii A w l Reconnect only 67.84 2
Apo )CONTRACTOR tC Z/�rl�' [ Pump or irrigation circle 67.84 2
Business name: )Io ;A:, hie Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: P.(7;Bo/ 22;733 panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: P '+ O , q 72S-6
Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(SO3) y will) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: 7' / /04//f• Industrial plant(I hr min) 78.18/hr
/pill 1 t Inspections for which no fee is
CCB Lic.:jS317d 1/- 'Electrical Lic.:'V 39ye Suprv.Lic.:4'235 specifically listed(''/hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
/°�� Subtotal: MC. 76
Print name: �l C� �,„/` v Date: f �� ❑Plan Review Required(25%of permit fee):
1r t% State surcharge(12%of pent fee): /A .0$
Authorized signature:/� 0 r
TOTAL PERMIT FEE: // .r�I
//�� ,� Jt � This permit application expires if a permit is not obtained within 180
Print name: �)�11/ J Date:/ ”ci,t,i� days after it has been accepted as complete.
Iv I u t� * Number of inspections allowed per permit.
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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
DescriptioFee for all residential systems combined: $75.00 n I Qty. I Each I Total I
3' 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 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('/hr min)
COMMERCIAL WORK'` . Y: ELECTRICAL PERMIT FEES
Subtotal Enteron 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
❑ 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
I:\Building\Permits\ELCPermitApp_ELR_ERE.doc Rev 06/17/2015