Permit CITY OF TIGARD ELECTRICAL PERMIT
B COMMUNITY DEVELOPMENT Permit#: ELC2017-00956
T R ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/28/2017
Parcel: 2S102CC04400
Jurisdiction: Tigard
Site address: 13765 SW ASH AVE
Project: BRUNER Subdivision: BEREA Lot: 5
Project Description: Replacing(1)200 amp service panel and(4)branch circuits for kitchen remodel.
Contractor: OWNER Owner: BRUNER, IAN M
IAN BRUNER 13765 SW ASH AVE
13765 SW ASH TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-475-0745 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 12/28/2017 $100.70
Specifics: amps or less
4 crt Branch Circuits w/Purchase 12/28/2017 $29.68
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 12/28/2017 $15.65
Electrical
Type of Const:
Occupancy Grp:
Total $146.03
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. Yo ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �� Permittee Signature: 5r O`ea C
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.
5, TT VI
`ElectriLal Permit Application QI ti ;\ ,. FOR OFF1cI: t SI.011.1
t
City of Tigard Received
: 0 /7 .�J ;
13125 SW Hall Blvd.,Tigard,OR 97223 4y { Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 ' ' Date/B : TIIM
Related Permit#:
Inspection Line: 503.639.4175 �. Ready Date/By: Juris: ® See Page 2 for
T I G A R D Internet: www.tigard-or.gov [ 'i G/ d a�' 1 i, 5k.`Notified/Method: Supplemental Information
TYPE OF WO 1jja iNi IVIS O PLAN REVIEW
0 New construction ddition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition IDOther: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION 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.
1Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 3-7(?S Susi Stf -141-V"-__ 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: G4...--)A..." "2_1_
Six or more residential units. occupancy.
ty 1 2 2 3 0 Recreational vehicle parks.
0 Health-care facilities.
Suite/bldg./apt.#: Project name: v ';y
s ' -yZ. L l 12 i-14-7'u 0 Hazardous locations. 0 Supply voltage for more than
�5 ❑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 I *
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
+� (with above sq.ft.) 75.00 2
P'� r'JJ90 e'<— fal/4IG�4N� (ff Y�.1V�4 E Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
{ PROPERTY OWNER 0 TENANT Services or
Energy 0 See Page 2
or feeders installation,alteration,and/or relocation
Name: v ISIL 0 1,,,,-:1_ 200 amps or less I 100.70 2
Address: I c,S-- s t,,,/ A.1 k-1-- 1k,(' 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 11(,4\-.(2.b (v IL ,,;--.7 1--'-2- 601 amps to 1,000 amps 301.04 2
Phone:( 3 ) et i s---0`7c(,S' Fax:( ) Over 1,000 amps or volts 552.26 2
(O e..„,,t r'j�!!.i 4,,..,3„, Temporary services or feeders installation,alteration,and/or
Email: ° _ idy �iGt 4 r.tbrelocation
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,re or ange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: '
Date: I Li2x,� �
f 401 amps to 599 amps 168.54 2
0 APPLICANT 0 CONTACT PERSON Branch circuits–new,alteration,or extension,per panel
A.Fee for branch circuits with 4Business name: above service or feeder fee, 7 42 Z f"O`� 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
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
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signa
-energy
Address: panel,alteration,or
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:( ) 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(1/2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: I S0.3
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): jr;4
Authorized signature: TOTAL PERMIT FEE: I Li—L,,0—
This permit application expires if a permit is not obtaihed within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PennitApp_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 SCHEDULE"`'
Fee for all residential systems combined: $75.00 Description I Qty. Each Total
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
n 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 90.00/hr
specifically listed('/z hr min)
COMMERCIAL*?URK O ELECTRIC,t ,P.ERMIT FEES
�� 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*
❑ 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.doc Rev 06/17/2015
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2017-00956
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 12/28/2017
TIc.,�RC� 9
Parcel: 2S102CC04400
Jurisdiction: Tigard
Site address: 13765 SW ASH AVE
Project: BRUNER Subdivision: BEREA Lot: 5
Project Description: Replacing(1)200 amp service panel and(4)branch circuits for kitchen remodel.
Contractor: AMERICAN ELECTRIC SERVICE Owner: BRUNER, IAN M
PO BOX 1057 13765 SW ASH AVE
SHERWOOD, OR 97140 TIGARD, OR 97223
PHONE: 503-537-2121 PHONE:
FAX: 503-554-8506
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 12/28/2017 $100.70
Specifics: amps or less
4 crt Branch Circuits w/Purchase 12/28/2017 $29.68
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 12/28/2017 $15.65
Electrical
Type of Const:
Occupancy Grp:
Total $146.03
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 0 952-001-0090 Yo may ob a copy of the rules or direct questions to OUNC by calling 503.232.198^p1:200.332.2344.
Issued By: 4 � Permittee Signature:
OWNER INSTALLATION ONLY U'
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 Application FOR OFFICE USE ONL\
City of Tigard giEGEI eceived
- Ok / I1 'ennit#i:LC2J `�e212y
qi 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: .� �_ /
III Plan Review
C Phone: 503.718.2439 FEB 1 2 2018 Date/By: Related Permit#:
Email: TigardBuildingPermits@Tigard-or. ov ReadyDate/By: Juris: 63 See Page 2 for
IIGARD
Inspection Line: 503.639.4175
Interne f. Supplemental Information 1ppRD,.,n `
TYPE OF WAW1LDiNQ"DIV/ 1ON
PLAN REVIEW ''
❑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 0 Building over three stories.
0 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.
-and 2-family dwelling ❑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 ❑Other:
0 Fire pump. 0 Installafion of 150 KVA or
JOB SITE=„INFORMATION AND LOCATION ; ; 0 Emergency system. larger separately derived
Job#: Job site address: 7. 7' f r�/ 0 Addition of new motor load of system.
C.,_5---'
�i .....s-- .L,G _) 100HP or more. ❑"A","E","l-2","1-3",
City/State/ZIP: ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE ,y,,
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORT .,,,,:k • . '' Limited energy,residential
/� r (with above sq.ft.) 75.00 2
Cel A/ 7 7 7 /'-/� 6'12 C t f/7 Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
PROPERTY OWNER TENA I Renewable Energy 0 See Page 2
.. Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
City/State/ZIP:
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
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
'❑ ArPLICAINT5f, ' Y ' t ®•`CO1NT�1.1C1'P:1<' OI i .t Branch circuits c new alteration or extension,per panel
A.Fee for branch circuits wit{:
Business name: above service or feeder fee, L,/
each branch circuit (C 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Each manufactured or modular
dwelling, 67.84 2
Email: service and/or feeder
4, * >CONTRACTOR , x x,
Reconnect only 67.84 2
` , Pump or irrigation circle 67.84 2
Business name: (7 �/ 4 S(l_ t At— Sign or outline lighting 67.84 2
Address: f�Ll die.!)�ll�,Q /d, Signal circuit(s)or limited-energy
�a "7� /C/c 7 panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: 54,,,.#64/0.0e, 0/2__ 5 ?/47T Each additional inspection over allowable in any of the above
(/ Additional inspection(1 hr min) 66.25/hr
Phone:(Spy S� �� A' f�-� Investigation(1 hrmin) 90.00/hr
�
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.:`p/5 7 Electrical Lic.: Z-19; Suprv.Lic.: c��,14�' specifically listed(%z hr min) 90.00/hr
Suprv.Electrician signature,required: / LECII2CAL PERMIT FENS
1 0"1�� Subtotal:
Print name: eect/I,v Fa[_®�C�f� t Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%ofpennit fee):
Authorized signature: TOTAL PERMIT FEE:
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 10/26/2017 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 SCHEDULE fi
Description Qty. Each 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:
n 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
n Vacuum Systems.* >100 kva-no additional charge 0.0 3
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)
= 'ELEtTR CAI 'FERMI FEES
C 'Y 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
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
Fl Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitAppELR_ERE.doc Rev 10/26/2017