Permit (36) CITY OF TIGARD ELECTRICAL PERMIT
�� Permit#: ELC2017-00452
``��JJ " ` COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439Date Issued: 06/15/2017
T t Parcel: 2S 103AA02400
Jurisdiction: Tigard
Site address: 12270 SW 106TH DR
Project: Lefever Subdivision: CLYDESDALE Lot: 5
Project Description: Replace damaged panel
Contractor: STAR ELECTRICAL SERVICE Owner: LEFEVER,WILLIAM JAMES
PO BOX 1784 12270 SW 106TH DR
BEAVERTON, OR 97075 TIGARD, OR 97223
PHONE: 971-998-7254
503-579-9201
FAX: 503-579-4581
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 06/15/2017 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 06/15/2017 $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 i c ai bject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done i accordance wi approved •lans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. TENTION: Oregon :w quirs • to follow the rules adopted by the Oregon Utility Notification Center. Those rules set forth in OAR
952-0 1-0010 through OAR 952-000 -0090. Y, -y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 r 1.800.33 34 .
Is ued B , �_/► // / Permittee Signature:
By:
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' AL /�1 �/ /���i� Date: 6,//
LICENSE NO. •g/ f 3 5
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 Applicati IVED mit milt 1. Iasi.ovl.l
City of Tigard Date/Bea ��e!!J Permit#: i _e ,Jr-
!IN 111 13125 SW Hall Blvd.,Tigard,OR 97223 lk 1
11 1 b 2017 Plan Review
i Phone: 503.718.2439 Fax: 503.598.196 Date/B : Related Permit#: _� �.0
Inspection Line: 503.639.4175 CITY .�� p Ready Date/By: Juris: H See Page 2 for
TI G A R D RO
Internet: www.tigard-or.gov r1 Notified/Method: Supplemental Information
AlN0 DIVISION
TYPE O PLAN REVIEW
❑New construction Addition/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.
❑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.
Ar 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
/ /04./}) ❑Addition of new motor load of system.
Job#:
j Job site address:/437�� i42/ � 100HP or more. ❑«A» «E„ '1 2„ "l-3„
Ci /State/ZIP: ❑Six or more residential units. occupancy.
(2`,,� (-./ / q�,� 0 Health-care facilities. 0 Recreational vehicle par .
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.
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 WORK Limited energy,residential
y (with above sq.ft.) 75.00 2
et: 7/ `f1 (5).(>1Citic/7/3(1.0e, , /IOii/ '' Limited energy,multi-family
f (:/-- residential(with above sq.ft.) 75.00 2
Id PROPERTY OWNER 0 TENANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: ' `/2r 200 amps or less 4 100.70 /,,2i 2
YY y `/ Z Vga)/(,.., 201 amps to 46100,0000a mps 133.56 2
Address:/,„:2� y `' /
�-[ i/ (O✓ 401 amps to amps 200.34 2
City/State/ZIP: r ()+, 9"7 601 amps to 0 amps 301.04 2
Phone:(/7 ) Fax:( ) Over 1,000 amps or volts 552.26 2
4,_ / 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
,APPLICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: 'f
c.....7----
� r / CP �/f�� C above service or feeder fee,
7.42 2
t ��'������ � 6. each branch circuit
Contact name: t_2� B.Fee for branch circuits without
0 service or feeder fee,first
/
Address: , 5,,,,,..;y / 7 branch circuit 56.18 2
City/State/ZIP: ,_ c7_,,.(A, K-'„/��) �7) ° Gil 70x}' Each add'I branch circuit 7.42
s C C Miscellaneous(service or feeder not included) 2
Phone:(fj��j) /�.-7 c, --9-,-7,55), 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
e
Business name: yw Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
AddrAddress: h e, S� / panel,alteration,or extension.
City/ess: ZIP: e6,
/' 91-2 .0,(#
Each additional inspection over allowableinany of the above
��k � /G 7/ l;�( _ Additional inspection(l hr min) 66.25/hr
Phone Q ) 7/,. ---, 9J Fax:( ) Investigation(1 hr min) 90.00/hr
Email: l Industrial plant(1 hr min) 78.18/hr
J 2 Lh /, Inspections for which no fee is 90.00/hr
CCB Lic.:/ 6-7 Electrical Lice-j7,z/-c, Suprv.Lic.: 94`;�j specifically listed('/Z hr min)
j / ✓ ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: q—kr- `, /- _ Subtotal: raj'. 7)
Print name: D” a ' 0 Plan Review Required(25%of permit fee): - —
State surcharge(12%of permit fee): /A.ell/ TOTAL PERMIT FEE:
Authorized signature: / 01.7 8
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\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
Fee for all residential systems combined: $75.00 Description Qty. Each Total
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
9 Audio and Stereo Systems* 15.01 to25 kva 200.34 2
Wind generation systems in excess of 25 kva:
9 Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
9 Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
9 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:
ri 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)
ELECTRICAL PERMIT F.EES:.
COMMERCIAL WORKS '.: Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
9 Audio and Stereo Systems
9 Boiler Controls
9 Clock Systems
9 Data Telecommunication Installation
9 Fire Alarm Installation
9 HVAC
❑ Instrumentation
n Intercom and Paging Systems
9 Landscape Irrigation Control*
9 Medical
9 Nurse Calls
n Outdoor Landscape Lighting*
9 Protective Signaling
9 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