Permit (179) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2018-00155
Date Issued: 03/05/2018
T f ?p P D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S114BB19600
Jurisdiction: Tigard
Site address: 10267 SW ELISE CT
Project: AG Planning LLC Subdivision: RIVERVIEW ESTATES Lot: 42
Project Description: Reconnect only.
Contractor: Owner: USA SECRETARY OF HOUSING&URBAN
BY MICHAELSON, CONNER&BOUL INC
4400 WILL ROGERS PARKWAY#300
OKLAHOMA CITY, OK 73108
PHONE:
PHONE
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 03/05/2018 $67.84
Specifics: 1 ea 12%State Surcharge- 03/05/2018 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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-Or•r •. •-• ••ain a ••y of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.33 ,2344. \ ,
Issued By: /siref�rminee Signature:
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 503.639.4176 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 A licatio ' .Y ,
pp _,-.1
FOR OFFICE: USE ONE1isr IL "
- City of Tigard
n Received
Date/B : �j� i
III
13125 SW Hall Blvd.,Tigard,OR 97223 IIMMIll
Plan Review
Phone: 503.718.2439 MAR i.�>> Date/B : Related Permit#:
Email: TigardBuildingPermits@Tigard-or.gov Ready Date/By: ® See Page 2 for
T I G A R D Inspection Line: 503.639.4175 Inte
nlGtt D Notified/Method: Ififf.„111MISupplemental Information
TYPE OF NV , j�1S10N ' ""` PLAN REVIEW- ' '
INCx
❑New constructioILA
n /�Addition/alte .l -i acement 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 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY O1 CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
-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.
❑Multi-family 0 Master builder 0 Other: ❑Fire pump.
� P P 0 Installation of 150 KVA or
JOB SITE IN 'PION AND LOCATION,:`'n 0 Emergency system. larger separately derived
RMA
_ ❑Addition of new motor load of system.
Job#: 1.--"-Job site address:/#9c 7 S vV l i S"...e LT
_ , l0OHP or more. ❑"A","E","t-2","l-3",
City/State/ZIP: �ej��jr, /9' 7,;t-2,(f-
l ❑Six or more residential units. occupancy.
�' t5� 0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: r/ Project name: AG iA{L� ' 0 Hazardous locations. 0 Supply voltage for more than
I ��` ��V ) ❑Service or feeder 600 more. 600 volts nominal.
Cross street/directions to job site: ✓✓✓ FEErSCHEDULE
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
,'OESC • ;. ION''OF WORK Limited energy,residential
,,�,n,, }- (with above sq.ft.) 75.00 2
`rr"c �� Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
PROPERLY OWNER ,:. r"�' j ��, EN, ° v Services or feeders installation,alteration,and/or relocation
Name: A j?4t ,/tic LL 200 amps or less 100.70 2
`tel L
Address: //7( 7 /�iyi � pl 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
�i'
City/State/ZIP: rcT2 lY��j > l„zd 601 amps to 1,000 amps 301.04 2
Phone:(97/) 3 2 2/-- 3 9, ? - 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,• , change,according to ORS 447,449,670,and 701. p 201 amps to 400 amps 125.08 2
Owner signature: ,�/�� 'c —� Date:-j--e-d�J/$ 401 amps to 599 amps 168.54 2
G! Branch circuits—new,alteration,or extension,per panel
,,,, 0 ' .:"'R6 . .CONTACT PERSON, 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
Address: branch circuit 56.18 2
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only j 67.84 C 7.kit2
. ;, ,. C RACTOR =u Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,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:( ) 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('V hr min)
'=4LE , . CAL PE FEES ,. '.
Suprv.Electrician signature,required:
Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): r, ih
Authorized signature: TOTAL PERMIT FEE: '17-,4-tt�
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_ELRERE.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 TIAL WORK ONLY: FEE SCti E
--��. .. �� 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:
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
n 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
n 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(1/2 hr min)
EL CTii1CAL PERMI F-FEES
Co t WORK OIJY
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*
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
I:\Building\Permits\ELC PermitApp_ELR_ERE.doc Rev 10/26/2017