Permit (124) CITY OF TIGARD ELECTRICAL PERMIT
s
• COMMUNITY DEVELOPMENT Permit#: ELC2018-00744
Date Issued: 11/13/2018
T I(. A It.i) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S103DA03700
Jurisdiction: Tigard
Site address: 10865 SW PARK ST
Project: MUELLER Subdivision: None Lot: None
Project Description: Adding(2)ground rods to ground the panel.
Contractor: AC ELECTRICAL CONTRACTOR LLC Owner: MUELLER, CARSTEN
5 CENTER POINTE DR SUITE 400 POPOVA, DIANA
LAKE OSWEGO, OR 97035 10865 SW PARK ST
TIGARD, OR 97223
PHONE: 503-910-3514 PHONE:
FAX: 503-845-9633
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 11/13/2018 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 11/13/2018 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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. • e rules are set forth in OAR
952-001-0010 through OAR 52-001-0090. You m y obtain a cop of the ules o direct questi::::::
alling 503.232.1987or1 :22344Pe `%% �Z ./
:
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 Application1. E
. FOR OFFICE USE ONLY
Received
City of Tigard 1 Date/B : I ' ___ - '
2018 ,i.� _ ,.
® 13125 SW Hall Blvd.,Tigard,OR 97223 N O V Plan Review - /
' a Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit 4:
Inspection Line: 503.639.4175 CITY f ;r4ARD Ready Date/By: Sufis: ® See Page 2 for
TIGARD Internet: www.tigard-or.gov BUILDING D?V;S, ,i• Notified/Method: Supplemental Information
a `::O1F " ,RN a
PLAN R '"IxIE , ;. ,
O 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 ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
, C4TEGORY ( OSTIft1J LEON exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑commercial-use agricultural
IX 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building
amps for all other installations. buildings.
O Multi-family ❑Master builder 0 Other: ❑Fire pump. ❑Installation of 150 KVA or
i I i #. .- .,
':::,,74.4,..0'.::.':'. �, � ,��� � �" tE t ❑Emergency system. larger separately derived
Job#: Job site address: tog 6s- P G.,t& C 0 Addition of new motor load of system.
J 100HP or more. 0 system
"E","1-2","1-3",
City/State/ZIP: i_ ❑Six or more residential units. occupancy.
c(;L"�� ` ❑Health-care facilities. CI Recreational vehicle parks.
Suite/bldg./apt.4: Project name: ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:
Description I Qty. I Each I Total 1
New residential single-or multi-family dwelling unit.
Subdivision: Lot 4: 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
-$P,,,,,::,,',:,,, Limited energy,residential
1 (with above sq.ft.) 75.00 2
clAA. 4.WC".y %c-e, U-s k c.. -cot �. Limited energy,multi-family
U �J residential(with above sq.ft.) 75.00 2
4 eA ' Renewable Energy 0 See Page 2
'l- ❑ 1' ....
-% ���>... �� 4 u�•>' � �N " ' � Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less t 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) 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 4 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
Branch circuits—new,alteration,or extension,per panel
,r.N.. .[:,,,;,-..i, ,.,,,::,, �' � ` 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
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
arc T
a gt.. Pump or irrigation circle 67.84 2
Business name: A G•I k_,,,CCL\ cz��„,,(3....A.,,,„- kL.cz Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: ce_t...„4,e,( etc,,,,..A. sLrl e...0.-)(:), panel,alteration,or extension.
/ _ �f Each additional inspection over allowable in any of the above
City/State/ZIP:
\,0,_\<_e__ c .SCJ } IZ Additional inspection(1 hr min) 66.25/hr
Phone:(5c), -I Lc) *_ _S-1
_1 LI :( ) Investigation(1 hr min) 90.00/hr .
[ � tIndustrial plant(1 hr min) 78.18/hr
Email:c1....e.(,C�-{l ,�I\ G.,..L�C�-C:. C /&L_C (0 y OLEO a Cc.:..4_, Inspections for which no fee is
s ecificall 'sted %z hr min 90.00/hr
CCB Lie.:( 4.6s'g. Electrical Lie.: C 30 ( Suprv.Lic.: 5 s( q S p" , y ( )
n � EL CTRL AL PP 211 IT I E�
Suprv.Electrician signature,required: t t,,(� G„...,,,1,,,,,\�c Subtotal:
Print name: R®b�,A..0 C ,r- ‘1.0‘. Date: i, ( 3 1 t g' 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature:
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 06/17/2015 440-4615T(11/05/COM/WEB