Permit (47) CITY OF TIGARD ELECTRICAL PERMIT
1s COMMUNITY DEVELOPMENT Permit#: ELC2018 00158
T f G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/06/2018
Parcel: 2S 101 BCO2300
Jurisdiction: Tigard
Site address: 12530 SW HALL BLVD 100
Project: Chris Gillett Insurance Subdivision: None Lot: None
Project Description: (3)branch circuits for NC unit,furnace,and service outlet.
Contractor: LEONARD ELECTRIC INC Owner: CHRIS GILLETT INSURANCE INC
PO BOX 411 19522 SW NAEVEST
HUBBARD, OR 97032 TIGARD, OR 97224
PHONE: 971-570-8103 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 03/06/2018 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/06/2018 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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. II work w
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 su •ended f• .ore the 0
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Th. e • -s -re > forth in 0
952-001-0010 through 0 52-001-0090. Yo, obtai rules or direct questions to OUNC by calling 503.232.1987 or,,,,,?.0y,,:°.2 /
Issued B -;.. z-� 'rte ��!
Y cr Permittee Signature: /�' �'
i
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.
Electrical Permit Application
City of Tigard te/By:ed - e, _ J f
- I` c Permit#: aV' fS ,--- r�i5�111 13125 SW Hall Blvd.,Tigard,OR 97223 _ i
� n Review
Phone: 503.718.2439 Fax: 503.598.1960 s d� ;'I bate/By: Related Permit#:
Inspection Line: 503.639.4175 - ' ReadyDate/By: H See Page 2 for
TIC ARU �,= Juris:
Internet: www.tigard-or.gov t• - Notified/Method: 77-- Supplemental Information
TYPE OF WORK �,n AR ► 0 PLAN REVIEW
❑New construction ®Addition/alteration/replace}fl�nt } , Please check all that apply(submit 2 sets of plans w/items checked):
,s`
Lli . ;'' "51. y ON a ❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: ')
yy L .:1'' where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCT i j L exceeds 10,000 amps at 150 volts or
P 0 Floating buildings.
El 1-and 2-family dwelling m Commercial/industrial lt]` sory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family ❑Master builder 0 Other: 0 Fireum
P P• 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: a 3O�/� }7 0 Addition of new motor load of system.
5 S o Halt t Jl vd 100HP or more. ❑ <A> E„ l-2> 'l_3„
City/State/ZIP: `T It OR 9-7 aa3 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: ja' I Project name: 'i .,i ❑Hazardous locations.
0 Supply voltage for more than
Tn% 0 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: I 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
3C�/ S - AA- (with above sq.ft.) 75.00 2
cbl'/` G� se'i/,,_e p/�y Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
0 PROPERTY OWNER I El TENANT
Renewable Energy ❑ 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:( ) I Fax:( ) 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
0
`APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
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 1 56.18 56.1(6
branch circuit2
City/State/ZIP: Each add'l branch circuit
a 7.42 <</,$'y 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular
dwellin s 67.84 2
Email: g, ervice and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: leo AXE r e eke f to roc.. zflie. Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: /Op tibue ea
panel, Page 2 2
panel,alteration,or extension.
City/State/ZIP: //4,44,,,,,1 ��� Cl'70 Each additional inspection over allowable in any of the above
� Additional inspection(1 hr min) 66.25/hr
Phone:(q7/)
$70 $vo- I Fax:(S"c3) if oZ 3 y/J' Investigation(1 hr min) 90.00/hr
Email: / / / 1 / Industrial plant(1 hr min) 78.18/hr
/te.t/e&y-d! @-6C'CTS I..G ,NG e1.A M' 1+I. c ery�, Inspections for which no fee is
CCB Lic.: 42/79 Ee Electrical Lic.: e, 11/ Suprv.Lie.: 6:20 S specifically listed(%hr min) 90.00/hr
Suprv.Electrician sigi Ite required: `j��
lei ELECTRICAL PERMIT FEES
��i� �/' Subtotal: -7I O a
Print name: /.� E' Date: /j 7/ 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): g.,5A
Authorized signature: TOTAL PERMIT FEE: 7 9 5.*
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.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL'WV ONL 1: :: FEE SCHEDULE Each Total
Description I QtY. I I I *
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 257.42 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(/hr min)
s=: E1 C" I( L RER14 I1 x EFS
(f I
CCIAi,WORK NL + maw,
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
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.doc Rev 06/17/2015