Permit (46) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT
Illi
Permit#: ELC2017-00592
Date Issued: 08/08/2017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S136CD01400
Jurisdiction: Tigard
Site address: 11654 SW PACIFIC HWY
Project: Massih Subdivision: None Lot: None
Project Description: Electrical reconnect
Contractor: N/A Owner: MASSIH,ABBAS
0836 SW CURRY ST, UNIT 400
PORTLAND, OR 97239
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 08/08/2017 $67.84
Specifics: 1 ea 12%State Surcharge- 08/08/2017 $8.14
Electrical
Type of Use: COM
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 ' accordanc- 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. TENTION: Oregon equires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-0 1-0010 through OA 2-001-1• 0
• . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
•Iss ed By: .9 I ' 1 Permittee Signature: x
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 Applica _4+ (.EIVEJ)
City of Tigard Received
IN13125 SW Hall Blvd.,Tigard,OR 97n2 Date/B : 8 8 7 �„t f1? Permit#: CaU/7-06 59,„q
= .Phone: 503.718.2439 Fax: 503.598 7 01/ Plan Review
Inspection Line: 503.639.4175 Date/B : Related Permit#:
T I G A R D � �� �� ReadyDate/By:Line:Pard-or.gov /OF GARS Juris: � SeePage2for
n�t� �i Notifled/Method:
Supplemental Information
TYPR D 'VISION PLAN REVIEW
❑New construction 0 Addition/alteration/replacement Please check all that apply pp y(submit 2 sets of plans w/items checked):
❑Demolition ❑Other: 0 Service or feeder 400 amps or more 0 Building over three stories.
CATEGORY OF'CONSTRUCTION where the available fault current 0 Marinas and boatyards.
exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 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.
❑Multi-family 0 Master builder
0 Other:
0 Fire pump.
El Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION
0 Emergency system. larger separately derived
Job#: I Job site address: (�t—G� � le Nw I% ❑Addition of new motor load of system.
�
1001IP or more. ❑"A" "E" "l-2""1-3»
0
City/State/ZIp: �'l C�,,vyG� it 1 2 3 ❑Six or more residential units. occupancy.
/ 77 i
Suite/bld /a t.#: I o Health-care facilities. 0 Recreational vehicle parks.
g• P Project name: /OAS j/f f 3U/t U/rij 0 Hazardous locations. 0 Supply voltage for more than
Cross street/directions to job site: ❑Service or feeder 600 amps or more. 600 volts nominal.
FEE SCHEDULE
Description I Qty. I Each I Total I *
Subdivision: New residential single-or multi-family dwelling unit.
I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
DESCRIPTION OF WORK Ea.add'I 500 sq.ft.or portion 33.92 1
A Limited energy,residential
E L f C T4( C, 4L_ A f eo A)N)El�t<_ (with above sq.ft.) 75.00 2
Limd y,mamily
resiitedentialenerg(with above sq.ft.) 75.00 2
0 PROPERTY OWNER J ❑ TENANT rgy ❑ See Page 2
Name: ` _ ServicesRenewable or feedersEneinstallation,alteration,and/or relocation
p I e-rro v Z tl c,t lGt Uct)16 n ,44.5f/// illi �J� ( ,(,)S 200 amps or less 100.70 2
Address: 9' 5/-jA,'05:4 201 amps to 400 amps 133.56
2
City/State/ZIP: �� ) < 401 amps to 600 amps 200.34
L�,xc QS�c�C c I ' 7C 35 2
601 amps to 1,000 amps 301.04 2
Phone:(. O 3) .1(J 41 LJL I-/C ' I Fax:( ) Over 1,000 amps or volts 552.26
2
Email: Temporary services or feeders installation,alteration,and/or
Owner installation:This installation is beingmade on propertysrelocation200amps
intended for sale,lease,rent,or exchange,according to ORS ,449,670,and 701.not 1 or less 59.368 1
201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54I
2
0 APPLICANT 1 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
Business name: A.Fee for branch circuits with
above service or feeder fee,
Contact name: each branch circuit 7.42 2
B.Fee for branch circuits without
Address: service or feeder fee,first
branch circuit 56.18 2
City/State/ZIP: Each add'l branch circuit
7.42 2
Phone:( ) Fax::( ) Miscellaneous(service or feeder not included)
Each manufactured or modular
Email: dwelling,service and/or feeder 67.84 2
CONTRACTOR Reconnect only 67.84 2
/L Pump or irrigation circle 67.84 2
�
Business name: iii Sign
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
Phone:( ) Additional inspection(1 hr min) 66.25/hr
I 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.: I Electrical Lic.: I Suprv.Lic.: specifically listed(%hr min) 90.00/hr
Suprv.Electrician signature,required: ELECTRICAL PERMIT,FEES
Print name: Subtotal r/a
I Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): $. ti
Authorized signature: TOTAL PERMIT FEE: 75 F
Print name: {� �` — l This permit application expires if a permit is not obtained within 180
.61,fku �a S 6+/vd l yl .1 Date: s%_ PP P
� LJ � days after it has been accepted as complete.
I:ltuIldingTermits\ELC_PertnitApp_ELR_ERE.doc Rev 06/17/2015 * Number of inspections allowed per permit.
440-46151(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
KONLY'* . Description I Qty I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 2
5 kva or less 100.70
Check Type of Work Involved: 5.01 to 15 kva 133.56 2
0
15.01 to 25 kva 200.34 2
Audio and Stereo Systems*
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
>100 kva—no additional charge fl 0.0 3
❑ Vacuum Systems* Each additional inspection over allowable in any of the above:
Each additional inspection is 66.25/hr 1
ID Other: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
s ecifically listed('/hr mm)
ONLY-"' r 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
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
O 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\ELC_PetwitApp_ELR_ERE.doe Rev 06/17/2015