Permit (41) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2017-00610
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/15/2017
Parcel: 2S103CC11900
Jurisdiction: Tigard
Site address: 12050 SW WHISTLER'S LOOP
Project: Vantage Homes LLC Subdivision: WHISTLER'S WALK NO.2 Lot: 66
Project Description: Reconnect only.
Contractor: VANTAGE HOMES LLC Owner: BUSSANICH,TYRON&JENNIFER
1761 THIRD ST,#103 12050 SW WHISTLERS LOOP
NORCO, CA 92860 TIGARD, OR 97223
PHONE: 951-444-7851 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 08/15/2017 $67.84
Specifics:
1 ea 12%State Surcharge- 08/15/2017 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through O .2-!I -0090. •.0 may obtain a copy of the rules or direct questions to OUNC by calling 5003.23/2.198�7LorrJ1.800.332.2344.
Issued By: r � Permittee Signature: vA/ f/i /°e-./
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.
REC
Electrical Permit Application E E
FOR OFFICE USE ONLY
City of Tigard Received�t
- a 13125 S W Hall Blvd.,Tigard,OR 97223 A C Date'B :d� �irl, Permit# �j �7�}� 8
Phone: 503.718.2439 Fax: 503.59 h Plan Revi w
Q-- ••�y Date B Related Permit#:
TIGARD Inspection Line: 503.639.4175 I m OP FI a A Ready Date By: ��"
r: Internet: www.tigat'd-vr.gvv BUIL
�}y� DING
Notified Ready Date Bo:4f.' ;fes- ” Bf See Page 2 for
i)�i I I t C l i I x $S rI SIO ' !Y Supplemental Information
TYPE OF WORK E/1 7L : S%5 PLAN REVIEW
0 New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans witems checked):
0Service or feeder 400
0 Demolition 'Other:e�.C_l Gq' Q i nn,Vu� amps or more ®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.
and 2-family dwelling 0 Commercial/industrial 0 Accessorybuildingless to ground,or exceeds 14,000
❑Commercial-use agricultural
0 Multi-family ❑Master builder 0 Other: amps for all other installations, buildings.
JOB:SITE INFORMATION AND LOCATION ❑Eire pump. ❑Installation of Sd KVA or
0 Emergency system. larger separately derived
Job#: i Job site address: I205,0 50 i-'1J_-5 j' ❑Addition of new motor load of system.
tlhlb TLQ.Y 100HPormore. ❑ A„ E i-2 „I_q"
City/State/ZIP: --�-p 1j 01-4-775
0 Six or more residential units. occupancy.
1 b arA,-GI i CR— 01
Suite/bldg./apt.#: '" I ❑Health-cam facilities. 0 Recreational vehicle parks.
I Project name: ❑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 Qtr. I Each I 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 WORK Ea.add'I 500 sq.11.or portion 33.92 1
C� � � �`T Limited energy,residential
Jn (with above sq.ft.) 75.00 2
Limited energy,multi-family
:.,
residential(with above sq.ft.) 75.00 Ila' 12
PROPERTY OWNER I 0 TENANT Renewable Energy 0 See Page 2 1
Name: �\' lQ Services or feeders installation,alteration,and/or relocation
U" 200 amps or less 100.70 2
Address: l-9—h l Mai v-� G.� \�2 201 amps to 400 amps 133.56 2
City/State/ZIP:NO W' C_74} c. 2 Q�� 401 amps to 600 amps 3200.34 o
1 L---F3 0 601 amps to 1,000 amps 301.04 2
Phone:(615 O 441- -.E35-� I Fax:
' ( ) Over 1,000 amps or volts 552.26 2
Email: a��T� tiltt.-,Van �\^On(1 \ CDm
Temporary services or feeders installation,alteration,and/or ?.
Owner installation:This installatidWis being made on pt rty that I own which is not 200 amps or less n a
intended for sale,lease,rent,or exchan e,according to S 447,449,670,and I. 20159.36 1 '
amps to 400 amps 125 03 2
Owner signature: 11+ �1�
C/` y� I�' D(>✓ 6 Date: 401 amps to 599 amps 168.54
t
0 APPLICANT I g CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
Business name:\Oa 1`- t��, \ c._... A.above
for brvi ch r fee a fee, g
p 4� �)` 0 6C ` above service yr feeder fee, t
each branch circuit 7 47 2
i i
Contact name: I no Oa(2.--Z
�L B.Fee for branch circuits without
Address: l� `ir� c JV • , service or feeder fee,first i
branch circuit 56.18 2
City/State/ZIP: a'(' ' c2 &Cr r Each add'l branch circuit 7.42 2
Phone:( � ) ( (� (�rt Fax: :((�J) Miscellaneous(service or feeder not included)
_1-361 IEach manufactured or modular
Email: dwelling,service and/or feeder 67.84
2
r� XJI u 1 Reconnect only 67.34 2
CO RACTOR r
Pump or irrigation circle 67.84 2
Business name:
Sign or outline lighting 67.84 i
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:( )
Investigation(I hr min) 90.00/hr
Email: Industrial plant(I hr min) 78.18'hr
inspections for which no fee is
CCB Lie.: 1 Electrical Lie.: I Suprv.Lie.: specifically listed(!%hrloin) 90.00!hr
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES
Subtotal:
Print name: I Date: 0 Plan Review Required(25%of pennit fee):
State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature: '7$, V,
Print name: i This permit application expires if a permit is not obtained within 180
Date: days after it has been accepted as complete.
I:Building Permits EI.0pp
.PermitA LIEFRE.Joc Kea 06 1"721/t5 - Number of inspections allowed per permit.
-140-4s15T(11X 05 CONI WEB
1
•
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description 1 Qty. 1 Each 1 Total 1 *
Fee for all residential systems combined: $75.00 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
with OAR 918-309-0040) 552.26 2
❑ 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
specifically listed(!i:hr min) 90.00/hr
COMIVIERCIAL WORK ONLY: ELECTRICAL sPERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enteron Page 1):
* 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
CHVAC
❑ 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
L Building Permits ELC_PermitApp_ELR_ERE.doc Rev 05 17 2015