Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
Permit*: ELR2018-00015
COMMUNITY DEVELOPMENT Date Issued: 01/30/2018
T iGAJ D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103DC00821
Jurisdiction: Tigard
Site address: 11290 SW FAIRHAVEN ST
Project: KIRKHAM Subdivision: VIRGINIA ACRES NO.2 Lot: 14
Project Description: Low voltage for audio and stereo system.
Contractor: OWNER Owner: KIRKHAM,TIMOTHY
TIMOTHY KIRKHAM 11290 SW FAIRHAVEN ST
11290 SW FAIRHAVEN TIGARD, OR 97223
OT,TIGARD 97223
PHONE:
PHONE:
FAX: FEES
Description
Date Amount
Restricted Energy Permit 01/30/2018 $75.00
Specifics: 0
12/a State Surcharge-Electrical 01/30/2018 $9.00
Type of Use: SF
Class of Work: ALT
Total Number of Systems:
Audio&Stereo: N
Security Alarm: N
Garage Door Opener: N
HVAC: N
Vacuum System: N
Other: Y Total $84.00
Other Desc:
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 wonb not
started Oregon Utility10 days
Notification issuance,
s ua ce, or r. if work Took is rules for more
the 180
AR
days. ATTENTION: Oregon law requires you to follow the -• ted Y g
952-001-0010 through OAR 952-001-0090. You may obtain a co•i of the rules or.'ect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Y
,Ii....,,
�� —�� ignature: r .
Issued By: -- = _ -
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.
d A VE p.
Electrical Permit Applicat s i .--- FOR MN( 1. I SF ON 1.)
City ofTigard _ Received y
u 13125 SW Hall Blvd.,Tigard,OR 97223 !
III ill Date/B : 0 �� Permit#: �� I.'_00 c—
ut
Review
Phone: 503.718.2439 Fax: 503.598.1960 . �l
.s Date/By: Related Permit#: 7. )2 y 33.
Inspection Line: 503.639.4175 i °t s kris:Ready Date/By: is: 0Seee Page 2 for
1 1 G A RD Internet: µ,w,µtiand-or. ov
g g rIk �;ri; Notified/Method: Supplemental Information
iia
TYPE PLAN REVIEW
0 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 0 Building over three stories.
❑Demolition ❑Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
Xand 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.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: 1 1240 9j j l rI_ _v� 0 100H Addition mf oew motor load of system.
-1+>vl rVll 100HP or more. ❑"A","E","]-2","1-3",
City/State/ZIP: 1 994 U f_ 0�7�� ❑Six or more residential units. occupancy.
f -1 t 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
Description I Qty. I Each I Total
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 WORK Limited energy,residential
, (with above sq.ft.) 75.00 2
f( (460(--iI
1 -1 � Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
'PROPERTY OWNER ❑ TENANT Renewable Energy 0 See Page 2 _
,/� Services or feeders installation,alteration,and/or relocation
Name: �)In44.,, le-Cr 16 i_ _ 200 amps or less 100.70 2
Address: 1 U S A r L Veih C� 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 'T,/,r r 0 M�? 601 amps to 1,000 amps 301.04 2
Phone:((.')( ) stat ry VL`3� "l Fax:(J ) 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 cco ding to S 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: I—70 "d 401 amps to 599 amps 168.54 2
Branch circuits—new,alteration,or extension,per panel
a APPLICANT 0 CONTACT PERSON
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 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:( ) Fax: :( ) Each manufactured or modular
dwelling, 67.84 2
Email: service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 6 lr,kt e/- Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy —,-See Page 2 �S-`€�y 2
panel,alteration,or extension. gr..
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
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed('/z hr min) 90.00/hr
Suprv.Electrician signature,required:
ELECTRICAL PERMIT.FEES
Subtotal: —?r,�
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 1-
Authorized signature: 77,,, 6 L r ,h441
TOTAL PERMIT FEE: ' L/,e:),,,
1 v� / This permit application expires if a permit is not obtained within 180
Print name: G ✓— Date: ',_ ?O —(z( days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELRERE.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:
A , ;"
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. I 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: 133.56 2
5.01 to 15 kva
nAudio 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
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
(1°(&)"11 Each additional inspection is 66.25/hr
Other: COcharged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(1/2 hr min)
ELECTRICAL PERMIT FEES
COMMXRPAL WORK 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
El Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n 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.doe Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11290 SW FAIRHAVEN ST, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Electrical Limited Energy ELR2018-00015
Inspection Type: Inspector:
198 Low voltage final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor