Permit (38) CITY OF TIGARD ELECTRICAL PERMIT
Permit#: ELC2017-00618
111, COMMUNITY DEVELOPMENT Date Issued: 08/21/2017
T[GFt.L? 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S136CB07000
Jurisdiction: Tigard
Site address: 11207 SW 81ST AVE
Project: Ford
Subdivision: HERB AND PEGGIE'S PLACE Lot: 13
Project Description: Panel replacement with(16)new branch circuits.
Contractor: OWNER Owner: FORD, MIKE&STACY
MIKE FORD 11207 SW 81ST AVE
11207 SW 81ST AVE PORTLAND, OR 97223
TIGARD, OR 97223
PHONE: 503-780-8319
PHONE:
FAX: FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 08/21/2017 $100.70
Specifics: amps or less
16 crt Branch Circuits w/Purchase 08/21/2017 $118.72
Type of Use: SF Service or Feeder
1 ea 12%State Surcharge- 08/21/2017 $26.33
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $245.75
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 OAR 952-001-0090 • a o. - . -copy of the rules or direct questions to OUNC by calling 503.232.1987 r 1.8 .332.2344.
Issued By: /,.f Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
Date:
OWNER'S SIGNATURE
CONTRACTOR INSTALLATION ONLY
Date:
SIGNATURE OF SUPR.ELEC'
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 Application FOR OFFICT CSI;O\L1
Received r� ' �'- Permit#: � 1 — Ij
III
City of Tigard Date/B
• 13125 S6 Hall Blvd.,Tigard,OR , Related Permit#: f� /
0 Phone: 503.718.2439 Fax: 503.598.196097223 ° Jur s: H See Page 2 for
dyDate/By: 10SeePage 2 Information
Internet: Line: 503.6 r.govj44 'Ei%
Notified/Method:
1 c;A R D Internet: www.tigard or.gov
PLAN REVIEW
TYPE OF WORK AUG
Please check all that apply(submit 2 sets of plans w/items checked):
❑New construction 0'Addition/alteration/replacemeri 0 Service or feeder 400 amps or more 0 Building over three stories. t
0 Other: T I Cx A RI} where the available fault current 0 Marinas and boatyards.
❑DelriOlitioriCITY exceeds 10,000 amps at 150 volts or 0 Floating buildings.
[�1-and 2-family dwelling 0 Commercial/indu y
CATEGORY OF CONST I+1l � 1
g5yg less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Fire pump. 0 Installation of 150 KVA or
Master builder 0 Other: largerntaseparately 0 KVA
❑Multi-family 0 ['Emergency system.
JOB SITE INFORMATION ANI? LOCATION ❑Addition of new motor load of system.
Job#: I Job site address: 1[ L 7 St..) `2 1 5 4 0 tfL100HP or more. ❑"A" "E","1-2" "1-3",
City/State/ZIP: .-rt GA IQ s ` Q 2 Z „..-1,
CI Six more residential units. occupancy.
o❑Health-care facilities. 0 Recreational vehicle parks.
0 Hazardous locations. 0 Supplvoltage for more than
Project name: 600 volts nominal.
Suite/bldg./apt.#: I J El or feeder 600 amps or more.
W P r �'7 4
Cross street/directions to job site: ✓ r L FEE SCHEDULE Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Lot#: 13 Includes attached garage.
Subdivision: 1,000 sq.ft.or less
168.54 4
/
Tax map/parcel#: I S i 3 C7 C_ — 0-700 t7 Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(with above sq.ft)
^6^LAG - r.40.. P��- !l c 4.4, /AA a Gtr w 1'T(^� Limited energy,multi-family 75.00 2
�(, �/' F'�/ r residential(with above sq.ft.)
N&‘A-) j 2 0-1P�t✓:t- Renewable Energy 0 See Page 2
Wi PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation 2
/' 200 amps or less 1 100.70 ,(,t)
Name: � � / 201 amps to 400 amps 133.56 2
I i 401 amps to 600 amps 200.34 2
Address: 1 301.04 2
/ ` '1. 601 amps to 1,000 amps I
City/State/ZIP: (/ 552.26 I 2
Over 1,000 amps or volts
Phone:(�a�) ' Z I Fax:( ) Temporary services or feeders installation,alteration,and/or
/� Mil relocation 1
Email: �1i�. � C/ �U 200 amps or less 59.36
Owner installation: is installation is teing made on property that I own which is not 9.36 2
intended for sale,lease,rent or `ge,acro 4• :, : ORS 447,449,670, d1 7 1.-] 12 201 amps to 400 amps 125.58 2
31
401 amps to 599 amps
Owner signature: �! Date: Branch circuits—new,alteration,or extension,per panel
❑ APPLIC- ® 0 CONTACT P RSON A.Fee for branch circuits with
above service or feeder fee, �'/ 7.42 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first 56.18 2
branch circuit 2
Address: Each add'1 branch circuit 7.42
City/State/ZIP: Miscellaneous(service or feeder not included)
Phone:( ) I Fax: ( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: 2
Reconnect only 67.84
CONTRACTOR Pump or irrigation circle 67.84 2
Sign or outline lighting
67.84 2
Business name: Signal circuit(s)or limited-energy
0 See Page 2 2
panel,alteration,or extension.
Address: Each additional inspection over allowable in any of the above
City/State/ZIP:
Additional inspection(1 hr min) 66.25/hr
90.00/hr
Phone:( ) Fax:( ) Investigation(1 hr min)Industrial plant(1 hr min) 78.18/hr
Email: Inspections for which no fee is 90.00/hr
CCB Lic.: I Electrical Lic.: I Suprv.Lic.: specifically listed('/z hr min)
p ELECTRICAL PERMIT FEES
Subtotal: i),.l y, La,Suprv.Electrician signature,required:
Print name: Date: El Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): _____,;26.. '.
TOTAL PERMIT FE)• (2.115-, 7 5
Authorized signature: I This permit application expires if a permit is not obtained within 180
I Print name:
days after it has been accepted as complete.
I Date: * Number of inspections allowed per permit.
I:\BuIlding\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
440-4615T(11/05/CAM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable EnergyPermit Fees:
es:
RESIDENTIAL WOW ONLY:; r.
Fee for all residential systems combined: z � E,E SCHEDULE � '
$75.00 Description 1 Qty. I Each I Total �I
i Renewable electrical energy systems:
-Check Type of Work Involved: 5 kva or less
100.70 2
❑ Audio and Stereo Systems* 5.01 to 15 kva 133.56 2
15.01 to 25 kva 200.34
2
0
Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04
2
Garage Door Opener* 50.01 to 100 kva 552.26
>100 kva(fee in accordance 2
n Heating, Ventilation and Air Conditioning with OAR 918-309-0040) 662.26 2
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑
Vacuum Systems*
>100 kva-no additional charge
I I 0.0
I I3
❑ Other: Each additional inspection over allowable in any of the above:
Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr 1
Inspections for which no fee is
CONMACIAL WORK ONLY: specifically listed(%2 hr min) 90.00/hr
Fee for each commercial system: $75.00
(SEE OAR 918-309-0000) Subtotal(Enteron Page 1):
* Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
O Data Telecommunication Installation
O Fire Alarm Installation
❑ HVAC
❑ Instrumentation
O 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:U3uilding\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015