Permit (176) CITY OF TIGARD ELECTRICAL PERMIT
11111 1. COMMUNITY DEVELOPMENT Permit#: ELC2017-00891
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/04/2017
Parcel: 1 S 134DA10800
Jurisdiction: Tigard
Site address: 10730 SW NORTH DAKOTA ST
Project: LARSON Subdivision: 1998-067 PARTITION PLAT Lot: 1
Project Description: Panel replacement.
Contractor: OWNER Owner: LARSON, WAYNE A&YVONNE M
WAYNE LARSON 10730 SW N DAKOTA ST
10730 SW NORTH DAKOTA TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-936-3132 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 12/04/2017 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 12/04/2017 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 co. • les or direct questions to OUNC by calling 503. 2.19 7 r 1.800.`1- .23.
-
Issued By: 9 . _ --? Permittee Signature: / /�
...00:101. f
OWNER INSTALLATION ONLYr.
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 ApplicationR'fiCIAIVE
City of Tigard Received /
13125 SW Hall Blvd.,Tigard,OR 97223 g 17 Date/By: ! /Zf//7 Permit#: �l�GOZ(�l '� ,..
Phone: 503.718.2439 Fax: 503.598.1960 1 1 O'° Plan Review DC(i GJ '
Inspection Line: 503.639.4175 ���.71
Date/By: Related Permit#:
TIG R D Internet: www.ti and-or. ov g'g eady Date/By: Juris:
g g i Li It 6Y.T tied Method: ® See Page 2 far
d, G 1WV5 I Supplemental Information
TYPE OF WO'
❑New construction '•
� PLAN REVIEW
t i Addition/alteratl.• - fa-Cement Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition Other:
0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION
Plici 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
❑Multi-family ❑Master builder ❑Other: amps for all other installations. buildings.
JOB SITE INFORMATION AND LOCATION 0 Fire pump. ❑larger
separately 150 KVA or
❑Emergency system. larger derived
Job#: Job site address: /6 /1j4467-13......„- ❑Addition of new motor load of system.
��� �// _ _ 100HP or more.
City/State/ZIP:' ❑Six or more residential units. occupancy.
Suite/bldg./apt.# — — ❑Health-care facilities. 0 Recreational vehicle parks.
Project name: T— 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 IQty. 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'l 500 sq.ft.or portion 33.92 1
`/ Limited energy,residential
RA1A 4 C 'et f+ �'J—, (with above sq.ft.) 75.00 2
/e% ` Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
OPERTY OWNER I ❑ TENANT Renewable Energy 0 See Page 2
Name: Services or feeders installation,alteration,and/or relocation
14/.4///f� 4, we A/ 200 amps or less
100.70 �GJC•1. 7G) 2
Address: 201 amps to 400 amps 133.56 2
City/State/ZIP: C 401 amps to 600 amps 200.34 2
Phone:,641 G, y � 1 �� ,33 601 amps to 1,000 amps 301.04 2
�) �rj F ( ) Over 1,000 amps or volts 552.26 2
Email: ///49 !✓ �� Temporary services or feeders installation,alteration,and/or
N�/ �t- i L� °ti�� {�(i, � relocation
Owner installa'tiolf.This installation is being made on propaFty that wn which is n t 200 amps or less
intended for sale,le. e,re or exchange,acc'jxling to ORS 447,449,670,and,701. ' 201 amps to 400 amps 168 59.365 I
Owner signature: O ,, / .58 2
r / - Date: 401 amps to 599 amps 168.54 2
0 APPLI ri CONTACT P •S t 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:( ) I 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
Pump or irrigation circle 67.84 2
Business name:
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(I hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.: I Electrical Lic.: I Suprv.Lie.: specifically listed(%3 hr min) 90.00/hr
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES
Print name: Subtotal: /C 7 ty
I Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 1 0
Authorized signature: TOTAL PERMIT FEE: d
IPrint name: I This permit application expires if a permit is not obtained within 180
I 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(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL
ORI(ONLY: �'' �' ,• .�. FEE SCHEDULE
Description
Each I 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
❑ 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 0.0 3
❑ Vacuum Systems* 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
specifically listed('/hr min)
ELECTRICAL PERMIT FEES"
COMMERCIAL RK ONLY 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
n Boiler Controls
Fl Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
n 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
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015