Permit (27) CITY OF TIGARD ELECTRICAL PERMIT
; . COMMUNITY DEVELOPMENT Permit#: ELC2018 00352
T t'C.;AvP D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/29/2018
Parcel: 2S 102 DB03400
Jurisdiction: Tigard
Site address: 13363 SW CHELSEA LOOP
Project: RYBKA Subdivision: CHELSEA HILL Lot: 11
Project Description: Panel replacement and(1)branch circuit for meter.
Contractor: OWNER Owner: RYBKA, KEVIN P&JESSICA
KEVIN RYBKA 13363 SW CHELSEA LOOP
13363 SW CHELSEA LOOP TIGARD, OR 97223
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 05/29/2018 $100.70
Specifics: amps or less
1 crt Branch Circuits w/Purchase 05/29/2018 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 05/29/2018 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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 - • • rules adopted by the Oregon Utility Notification C-ater. Those rules are et forth in OAR
952-001-0010 throughOAR952-001-0090. You m- •btain a copy o the rules or direct questions to OUNC by calling 5, .23 . oar/ ,.3 !�
%'
Issued By: i►����` ��" Permittee 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 503.639.4175 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 FSE O\l.I
City of Tigard � G O _ ReceivedINIMEEll
II Iii 13125 SW Hall Blvd.,Tigard,OR 97223 � 1 Q t a e➢31 i t Date/B : ii� i Y jam- "
: Phone: 503.718.2439 Fax: 503.598.194raVv-,)I�. `'1' i ? Plan Review Date/B Related Permit#:
1 I G A K D Inspection Line: 503.639.4175 t ! Ready Date/By: H See Page 2 for
Internet: www.tigard-or.gov p Z ��1/ Notified/Method:
Supplemental Information
TYPE OF WO° PLAN REVIEW
El New construction p Addition/altera? y .•ii.i #� " 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.
❑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.
p.1-and 2-family dwelling 0 Commercial/industrial ❑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: ❑Fireum .
p p 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
/ l ❑Addition of new motor load of system.
Job#: Job site address: r t ❑"A","E",°,1.2,,,"1-3",
��!i ! �N���}') 2c� � L ^ 100HP or more.
City/State/ZIP: I l 6 Jn / l./6\, t I'e)')"� 0 Six or more residential units. occupancy.
f' ` / ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I 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
/\./1 /.)-.
I Qty. 1 Each ► Total ► *
/Vp I/ Description
1 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'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WO Limited energy,residential
{^^ / i r-- P r �F-'" 75.00 2
IJ�' ( — Il / / (with above sq.ft.)
` j /_ t �/ J" "� Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
.PROPERTY OWNER 1 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: /<'j()1)/ [) 177) 1 200 amps or less I 100.70 fr71 2
Address: I ' ( - SIX)
) t La)
() 201 amps to 400 amps 133.56 2
q /� Y' � 401 amps to 600 amps 200.34 2
City/State/ZIP: ri ( ') 6lc 9,� 601 amps to 1,000 amps 301.04 2
Phone:(1 1( ) .�7 .SK(( 1C I Fax:( ) Over 1,000 amps or volts 552.26 2
Email: <j ,. () c rk - /� �j ( Temporary services or feeders installation,alteration,and/or
J v- # Js-rNit"—( 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,leas r t,o xchange �e • RS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: ��� Date: CI _ 401 amps to 599 amps 168.54 2
�;APPLICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 7 42 7�,� 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
Email: 67.84 2
Reconnect only 67.84 2
CONTRACTOR 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:( ) 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('/hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: /2.1
This permit application expires if a permit is not obtained within 80
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 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 SEDULE
., Description �I Qty• I Each I Total 1
Fee for all residential systems combined: $75.00 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) 55226 2
❑ 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('h hr min)
CTRICAL PERMIT x,.. S
COMMERCIAL' WORK NL :
'=`` �" LE Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 x 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:\BuildingPennits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015