Permit (264) CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT $r Permit#: ELC2016-00916
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ,4 Date Issued: 12/05/2016
T f c;A Iz Dg Parcel: 25111 CC15400
Jurisdiction: Tigard
Site address: 10055 SW HIGHLAND DR
Project: Clouser Subdivision: SUMMERFIELD NO.4 Lot: 205
Project Description: (8)branch circuits for kitchen remodel. 12/8/16,REPRINTED to add(4)more branch circuits.
Contractor: R&D ELECTRIC INC Owner: CLOUSER, PENELOPE L
PO BOX 868 10055 SW HIGHLAND DR
MULINO, OR 97042 TIGARD, OR 97224
PHONE: 503-679-7987 PHONE:
FAX:
FEES
Quantity Description Date Amount
8 crt Branch Circuits wo/Purchase 12/05/2016 $108.12
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/05/2016 $12.97
Type of Use: SF Electrical
Class of Work: ALT 4 crt Branch Circuits w/Purchase 12/08/2016 $29.68
Service or Feeder
Type of Const: 0 ea 12%State Surcharge- 12/08/2016 $3.57
Occupancy Grp: Electrical
45 Misc Administration Fee 12/08/2016 $45.00
Total $199.34
Required Items and Reports(Conditions)
This permit -4 subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do in accordance 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
day;. ATTENTION: Oregon aw .0 -s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95.-001-0010 through OAR 952-4,1-0090. Y.ay obtain a copy of the rules or direct questions to OUNC b 2.1987 or 1.809.332.2344.
Is;ued By: % / = 4_� Permittee Sign-ture:
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 'mmm'mm'mml of i i is I sr.0\1.)
City of Tigard IECEIVEI)
Received:
)/�
Date/B Permit#: EE6 OC 9/4
13125 SW Hall Blvd.,Tigard,OR 97223 5�
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Date/B Related Permit#:
I I G A K D g g and-or. ov = t? Notified/Method:Inspection Line: 503.639.4175 DEC 0 7 ?016 Ready Date/By: Juris:
Internet: www.ti See Page 2 nr
SupplementalInformation
TYPE OF W0 0141 GARD PLAN REVIEW
❑New construction 0 Addition/etf o i t Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0Building 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
❑Floating buildings.
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
0 Multi-family amps for all other installations. buildings.
Y 0 Master builder 0 Other: ['Fire pump.
0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: 0 Addition of new motor load of system.
Job site address: /QD h—, 7y
!¢mac i 100HP or more. 0
City/State/ZIP: 0 Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: 0 Hazardous locations. 0 Supply voltage for more than
Cross street/directions to job site:
0 Service or feeder 600 amps or more. 600 volts nominal.
FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
DESCRIPTION OF Ea.add'I 500 sq.ft.or portion 33.92 1
OF WORK
Limited energy,residential
�/`4 G� \
(e./
e./ 1 ex � .—. ( sq. t) 75.00 2
,--;.-_-
a1 C li-P 1/f, Limitedwith enerabove
gy,multi-family 75.00 2
residential(with above sq.ft.)
0 PROPERTY OWNER 1 0 TENANT Renewable Energy ❑ See Page 2
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
City/State/ZIP: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) I 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 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
0 APPLICANTI 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, `
Contact name: each branch circuit 7 42 ;47.4f( 2
B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Phone: Miscellaneous(service or feeder not included)
( ) I 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: ,, n Er Sign or outline lighting 67.84 2
Address: 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:( ) I Fax:( ) hr min Investigation(1
g ) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: I Electrical Lic.: I Suprv.Lic.: specifically listed(1/4 hr min) 90.00/hr
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES
Print name: A-1/113 CEti— Subtotal: A9.G g'
I Date: ■ . '- • • • ' • ;- : qc
-00
State surcharge(12%of permit fee): 5.47
Authorized signature: X TOTAL PERMIT FEE: *7 a5'
This permit application expires if a permit is not obtained within 180
I Print name: I Date:/7. (' I days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(I1/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
FEE SCHEDULE
RESIDENTIAL WORK ONLY: Description I Qty. I Each I Total I
*
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
❑ 15.01 to 25 kva 200.34 2
Audio and Stereo Systems*
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
❑ 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
>100 kva—no additional charge 0.0 3
❑ Vacuum Systems*
Each additional inspection over allowable in any of the above:
Each additional inspection is 66.25/hr 1
111 Other: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/hr min)
ELECTRICAL PERMIT FEES
COMSERCIAt WORK ONLY: Subtotal(Enter on Page 1): 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
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n 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\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015