Permit (57) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2017-00477
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/22/2017
f g Parcel: 2S102AB01801
Jurisdiction: Tigard
Site address: 9440 SW TIGARD ST A
Project: Risberg Subdivision:RTH TIGARDVILLE ADDITION,AMENC Lot: 56
Project Description: Electrical reconnect
Contractor: N/A Owner: RISBERG, RONALD G
COLE, BARBARA J
RISBERG, KATHRYNE H
4210 IMPERIAL DR
WEST LINN, OR 97068
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 06/22/2017 $67.84
Specifics:
1 ea 12%State Surcharge- 06/22/2017 $8.14
Electrical
Type of Use: MF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
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. AT TION: • ..on law requires you to follow the rules adopted by the Oregon Utility Notification C r. —hose rules are set forth in OAR
952-001 010 through OAR° 2-!
Electrical Permit Applicati :CIV i`
^� }�„ar. ,i� s F0120FFICC t:SC011.1
City of Tigard Received N� 20/7,60tJ
Date/B : � �•�' ) Permit#: oL
III IR 13125 SW Ha11 Blvd.,Tigard,OR 97223
s sn a i Plan Review
II Phone: 503.7182439 Fax: 503.598.19�Q _':' .2`' (L i r Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Juris: Vi See Page 2 for
TIGARD
Internet: www.tigard-or.gov C{ ' a . ' n t fr Notified/Method: Supplemental Information
TYPE ° 1(ill:TING DIVISIOj0 PLAN REVIEW
0 New construction ❑Addition/Aeration/replacement DIVISION 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 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
oamps for all other installations. buildings.
Multi-family 0 Master builder 0 Other: 0 Fireum
P P. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: 5a {J J /1 /� ❑Addition of new motor load of system.
t./ci 0 C(,J 16(9�'I't,{ ( 4 100HP or more. ❑
t: I t(,-LLT OrZeuca'l q 7'G 2-3 0 Six or more residential units. occupancy.
1 ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: ; .1('.0 ArZ15 eel, 0 Hazardous locations. 0 Supply voltage for more than
*� 6.1. ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description Qty. � Each 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
DESCRIPTIONF WORK Limited energy,residential
E L E0-r-12 r e Pr aeii N E c_7----
4
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
0
`.TENANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
01111110B v '^�n, �
�tasC�"'t�''" 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
��1 ' I 1�� 401 amps to 600 amps 200.34 2
fikottowatitzip: 601 amps to 1,000 amps 301.04 2
_{,4 --/- Lf- --tU t07 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
0 APPLICANT ❑ CONTACT PERSON Branch circuits-c new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:----1-46 y ------eQcyy l above service or feeder fee,
`t��7 each branch circuit 7.42 2
Contact name: 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
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwellin 67.84 2
Email: g,service and/or feeder
Reconnect only 67.844 2
0 RACTOR Pump or irrigation circle 67.84 �� 2
Business name: 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('/hr min) 90.00/hr
Suprv.Electrician signature,required:
ELECTRICAL PERMIT FEES
Subtotal: 6 7
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): ,F :/
TOTAL PERMIT FEE: 7.e�, g
1 This permit application expires if a permit is not obtained within 180
' Ito/�I(o/ ft 6-(Y5 i , ;y :l.,/ days after it has been accepted as complete.
*
S[ Number of inspections allowed per permit.
L\Building\Permits. _Permit .._ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB e``14 �(t4/1 rI
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
FEg ,ca»uvt
O NLY =,:
��TTA• �< �°,� � Description Qty � Each � 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:
❑ 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
n Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
Each additional inspection is
❑ 66.25/hr 1
Other. charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
spmifically listed('A hr min
CVOCIAL WORK ONLY:
4 �4 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:
[II 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*
n Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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