Permit (13) CITY OF TIGARDELECTRICAL PERMIT
.114....- u _.
Permit#: ELC2017-00692
' COMMUNITY DEVELOPMENT t Date Issued: 09/21/2017
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ITHI
�.[C�t�R,� M Parcel: 2S114AD03400
Jurisdiction: Tigard
Site address: 8958 SW WAVERLY DR
Project: Lewis Subdivision: WAVERLY ESTATES Lot: 33
Project Description: Install(1)branch circuit for hot tub. 10/31/17: REPRINTED permit to add contractor.
Contractor: HORTON ELECTRIC Owner: LEWIS, STEPHEN C&ANNE E
11266 SE 21ST AVE SUITE 107 8958 SW WAVERLY DR
MILWAUKIE, OR 97222 TIGARD, OR 97224
PHONE:
PHONE: 503-267-2797
FAX: 503-659-8864
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 09/21/2017 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/21/2017 $6.74
Type of Use: SF Electrical
45 Misc Administration Fee 10/31/2017 $45.00
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $107.92
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. You may obtain a copy of the rules or direct questions to OUNC by calling 5.232.11988,77 or 1.8 0.332.23`4,
Permittee Signature: JfJT� - bye
Issued By: �i�.��<-� k
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 Applicationroiz of rici: t sl:oyl.l
' ' �
City of Tigard �. �OA p .ate/B : '� ',
4 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Related Permit#:
II Phone: 503.718.2439 Fax: 503.598.1960 Date/B
Inspection Line: 503.639.4175 1 i' 31 2017 Ready Date/By: 366s. ® See Page 2 for
T I GAD Notified/Method: Supplemental Information
Internet: www.tigard or.gov t�°�g
YPE OF WORKCITY '1,.. 11(A 9 PLAN REVIEW
Please check all that apply(submit 2 sets of plans w/items checked):
0 New construction ddition/alteratio�3( l� l :' 0 Service or feeder 400 amps or more 0 Building over three stories.
�*jj t �,.�s. 1 J
❑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.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
>0"-and 2-family dwelling ❑Commercial/industrial El Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
0 Emergency system. larger separately derived
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of system.
Job#: Job site address: 8 1 S ��[ L' DQE IOOHP or more. 0"A","E","1-2","1-3",
1 ❑Six or more residential units. occupancy.
City/State/ZIP: `[i c A# ( 0_ Z z-4 Health-care facilities. 0 Recreational vehicle parks.
1 ( J 0 Supply voltage for more than
Pro ect name: 0 Hazardous locations.
❑Service or feeder 600 amps or more. 600 volts nominal.
Suite/bldg./apt.#:
Cross street/directions to job site: tit)Q tU- td FEE SCHEDULE
Description I Qty. I Each I Total
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 75.00 2
1 (with above sq.ft.)
N �`� Limited energy,multi-family 75.00 2
tco.c .,(,, residential(with above sq.ft.)
���r ✓a�� � it
�hlJi 1 �'t/3�/� 7 Renewable Energy 0 See Page 2
0 PROPERTY OWNER T NANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address: 401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( )
Fax:( ) Over 1,000 amps or volts 552.26 2
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
0A.Fee for branch circuits with
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
Each add'1 branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Phone:( ) 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
Business name:
0t�N G`ECT O-t Sign or outline lighting 67.84 2
r Q Signal circuit(s)or limited-energy
0 See Page 2 2
Address: 11 2_6.6 S� 2._.()� 5i-e- to 1�-7 panel,alteration,or extension.
�y Each additional inspection over allowable in any of the above
'Ai
City/State/ZIP: Wit LU114V K i u 6(� "-1� 2-2-zAdditional inspection(1 hr min) 66.25/hr
Phone:(51 3 k, q - 8 4,4 A Fax:( )
Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: rip 1 es do R k.@ k) .coi , Inspections for which no fee is 90.00/hr
Electrical Lic.: 1/_ Suprv.Lic.:q4 q 7 5 specifically listed(''7 hr min)
CCB Lic.: $ (� I ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: TA.y ti.t,viz NI ate: lobo I(1 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature: This permit application expires if a permit is not obtained within 180
Date: days after it has been accepted as complete.
Print name: * 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 for all residential systems combined: $75.00 *
RenewablenI Qry• I Each I Total I
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
111 Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating, Ventilation and Air Conditioning
System
* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
ElOther:
additional inspection over allowable in any of the above:
Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 lir min)
Inspections for which no fee is
ed('A hr min)
COMMERCIAL WORK9 .00/hr
specifically list
ONLY: . ELECTRICAL '�R1Vi1T p'EES $`
Fee for each commercial system: $75.00 subtotal(Enter on rage 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n C• lock Systems
11] D• ata Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
n Instrumentation
[11 Intercom and Paging Systems
El Landscape Irrigation Control*
11] Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Budding\Permits\ELC_PemutApp_ELR_ERE.doc Rev 06/17/2015
1
City of Tigard • COMMUNITY DEVELOPMENT DEPART
IVIAI
'CE IVIED
II
11
: 5 Request q est for Permit Action
T 1 G A R n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tig ,c_cl. o �17
TO: CITY OF TIGARD oily`y '. ,I.3 J r.4
Building Division ( $ ( ,v
3ui
13125 SW Hall Blvd.,Tigard,OR 97223
iV
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigardo :
or.gov
FROM: Owner E] Applicant ❑ Contractor II] City Staff
Check ✓ one
REFUND OR Name:
INVOICE TO: (Business or Individual) Ave ` &(S
Mailing Address: 5 Su) V a 1
City/State/Zip: 1741 til ore e 9
Phone No.: — '7 - 0 7?3
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
0 CANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
_frREMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: EL` :de/?--(1./94-6Z
Site Address or Parcel #: g``%5r 51..... i,,JtWr✓'j7 V..
,y6V- Ll1- Cl?
091
Subdivision Name: Lot#:
EXPLANATION: Mt,01 put(T_ 40 (46,..i-o U 1--
`-7 Ii°i C!
Signature: 417Ct/Z5 Date: I'®136X7
Print Name: Awl I ems
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
Route to Sys Admin: Date ji,r 3iii 7 By 5-l Route to Records: Date B
Refund Processed: Date By Invoice Processed: Date y
Permit Canceled: Date By
By Parcel Tag Added: Date By
I:\Building\Forms\RegPemvtAction_092314.doc
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2017-00692
13125 SW Hall Blvd.,Ti Date Issued: 09/21/2017
F c.;+ [.L and OR 97223 503.718.2439 9
Parcel: 2S114AD03400
Jurisdiction: Tigard
Site address: 8958 SW WAVERLY DR
Project: Lewis Subdivision: WAVERLY ESTATES Lot: 33
Project Description: Install(1)branch circuit for hot tub.
Contractor: OWNER Owner: LEWIS, STEPHEN C&ANNE E
ANNE LEWIS 8958 SW WAVERLY DR
8958 SW WAVERLY TIGARD, OR 97224
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 09/21/2017 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/21/2017 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 95 01-0090. You y obtain a co y of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: L2a
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.
7' .'"77---T1
t ,
Electrical Permit Applicati , FOR OFFICE LSE()NIA
• City of Tigard S E P 017 Received /� / / 4 �voZ0�7 ��
Permit#:
DateBy: 7 / (/�
13125 SW Hall Blvd.,Tigard,OR 97223Plan Review
Phone: 503.718.2439 Fax: 503.598/1960 NI Date/By: Related Permit#:
Inspection Line: 503.639.4175 v, , ,:, v..„ ;',1 Ready Date/By: turfs: Pi See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
❑New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition 0 Other: where the available fault current ❑Marinas and boatyards.
Al'104Y OAF CCN 1L C 'y' '` 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 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JO»•ST>C11 ' 11FC1`AMAf1�1 A1�Ip LOCTOIti1
' 7' 0 Emergency system. larger separately derived
' � El Addition of new motor load of system.
-r
Job#: Job site address: / J
8 t,Ol ��V pi L,\ On ve 100HP onnore. ❑`A" "E" "1-2" "1-3"
❑Six or more residential units. occupancy.
City/State/ZIP: t G G'r A OR Ck 7 a y 0 Health-care facilities. ❑Recreational vehicle parks.
C ❑Hazardous locations. 0 Supply voltage for more than
Suite/bldg./apt.#: Project name:
El Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: '. 4E SdnEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: ` 1 1Lot#: Includes attached garage.
��V Ir \� 5 t,_.‘.0 } 1,000 sq.ft.or less 168.54 4
Tax map/parcel#:"‘'
: Ea.add'l 500 sq.ft.or portion 33.92 1
_., PESCRtirri + ', OR
Limited energy,residential
2. �, 4:,"4„;,.;-,,, - . , 75.00 2
(with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewa
le Energy
See
", oPER1 N1 .. *c, *$T ,�:. '' Servicesi or feedersinstallation,alt0 Page
alteration,and/or relocation
Name: c t-\G S\ t 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address: t 9 g J.0 Ovi9 1 (),,,,\o
401 amps to 600 amps 200.34 2
City/State/ZIP:'1""; h O RCA PI a ay 601 amps to 1,000 amps 301.04 2
Phone:(S o 9Fax:( ) Over 1,000 amps or volts 552.26 2
a S q q 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,le, = rent,or exchange,a cording to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
4).wner signature Date: ch s amps 168.54
alteration,or extension'Per panel 2
/
401 amps to 599
Bran circuit
,I •f _ C 1'TAT T PJ ON A.Fee for branch circuits with
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: 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 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
................-_.........
I'I
III
II'
' CTO s ,I,:, Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: inspections for which no fee is
90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.:
specifically listed(%hr mm)
I',10iILECTR4CAL PM•C1;,; ES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
TOTAL PERMIT FEE: (Da,".2NAuthorized signature:
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(l l/05/COM/WEB
rrElectri.cal Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
.1E tl l IAt,, QI Nutt r
StligDULE
Fee for all residential systems combined: $75.00 Des`ript1on Qty. r Each f Total I *
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
❑ 5.01to15kva 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
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
Heating, Ventilation and Air Conditioning
System* Solar generation systems in excess of 25 kva:
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
charged at an hourly(1 hr min)
Inspections for which no fee is
specifically listed(%hr min) 90.00/hr
COMMERCIAL WOIk ONLY :ELEca talc L t Mt SES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
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
❑ L• andscape Irrigation Control*
n M• edical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ P• rotective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
8958 SW WAVERLY DR, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Electrical ELC2017-00692
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor
CITY OF TIGARD ELECTRICAL PERMIT
1111
COMMUNITY DEVELOPMENT Permit#: ELC2017-00692
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/21/2017
T j ''� O g Parcel: 2S114AD03400
Jurisdiction: Tigard
Site address: 8958 SW WAVERLY DR
Project: Lewis Subdivision: WAVERLY ESTATES Lot: 33
Project Description: Install(1)branch circuit for hot tub.
Contractor: OWNER Owner: LEWIS, STEPHEN C&ANNE E
ANNE LEWIS 8958 SW WAVERLY DR
8958 SW WAVERLY TIGARD, OR 97224
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 09/21/2017 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/21/2017 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 95 01-0090. You y obtain a co y of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.���
�'
Issued By: Permittee Signature: tJ //
L/Lt'G? 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.
Qk t r% a s T
r.Eleckrical Permit Applicata -: --'''~ "Y /) FOR OFFICE ( SE ONLv
City of Tigard SEP 2 . 2017 Date/B d ?tzt /7 id Permit 6: eoZO/7-1906,gqz
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review c
Phone: 503.718.2439 Fax: 503.598/1960 -"..) Date/By: Related Permit 6:
Inspection Line: 503.639.4175 ..,i ' o-„,..ti=.y Ready Date/By: Juris BI See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
❑New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATAGORY OF PONSTRDPRON exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ I-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
a 0 Emergency system. larger separately derived
JOB_SITE.INFORMATION AND �.()fCATItI;t1 :.-. 1 -.�` ':'
Job#: Job Site address: '� �, ❑Addition of new motor load of system.
V 5 J t.hl W aka l s w: On)(' 100HP or more. ❑"A" "E' "1-2" "1-3„
Six or more residential units. occupancy.
City/State/ZIP: % C c'fi:` Q S cc 7 2 y ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ❑Hazardous locations. ❑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
New residential single-or multi-family dwelling unit.
Subdivision: UJGAe cA� sk c ke 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
• ,� DI"Sa10 ,O ORR , '''':=', A''' Limited energy,residential
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
raOlPg *'b*lNl r, - El,TENANT " Services or feeders installation,alteration,and/or relocation
Name: (� t1nC l � S 200 amps or less 100.70 2
Tl
201 amps to 400 amps 133.56 2
9AAddress: C S. - )3 Q,,\I e f l 0,i-)q 401 amps to 600 amps 200.34 2
City/State/ZIP: y c)c, t\ 0 CA 11 2 j 601 amps to 1,000 amps 301.04 2
Phone:(c O�) C` Fax:( ) Over 1,000 amps or volts 552.26 2
5 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,le rent or exchange,a cording to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
?4,wner signature: Date: 401 amps to 599 amps 168.54 2
APPLICAN"I ,i lP1, y 5* 1'1TA ` PiRSON
Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
i3)
67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. ❑ 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 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed Wu hr min)
; TRICAL PERMIT FEES,1, •,' . '
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: Colo?.".2N
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.doe 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 WOOlt UOLY: °
,.. SEESCHEDULE
Description Qty. I Each I.. Total
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*
g pener >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
❑ 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(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
COMMERCIAL WOWONLY: ELECTRICAL PERMIT PEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
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*
❑ 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
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015