Permit Support Document Electrical Permit Application - - ► o►z 01 1 lc 1. 1 SI.t)Nl.l
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City of Tigard Received AWDateBMi� , = ♦ _ t e
13125 SW Hall Blvd.,Tigard,OR 97223 s r I F
Plan Revi-
' • Phone: 503.718.2439 ��`� E'' Date/B : Related Permit#:
Email: TigardBuildingPermits@Tigard-or.gov ,, Ready Date/By: Juris: ® See Page 2 for
I I(,A R n Inspection Line: 503.639.4175 Interneit OvtV.tagard-drgM Notified/Method: Supplemental Information
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TYPE OFr �v � PLAN REVIEW
KNew construction ❑Addition/alteration/replac t Q1J
Please check all that apply(submit 2 sets of plans w/items checked):
El Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
0 where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTIOexceeds 10,000 amps at 150 volts or ❑Floating buildings.
m ss to ground,or exceeds 14,000 ❑Commercial-use agricultural
El 1-and 2-family dwelling g.Commercial/industrial El Accessory
amps for all other installations. buildings.
El Multi-family El Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
C y �,�^ ❑Addition of new motor load of system.
Job#: i f (: I Job site address:,�]51 1 .S W lel k5t,t to c�-„,<, iO4-1) l00HP or more. ❑«A» «E» «1.2»«l_3„
City/State/ZIP: �j ✓ 0 Six or more residential units. occupancy.
ty Pt] V'"D i 0 l�' �1 ZZ'3 ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: CT tI Project name: D A-(c L 6. 0 Hazardous locations. 0 Supply voltage for more than
y ❑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: l 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 75.00 2
LOGO p c c (with above sq.ft.)
�"� �1 b u J�S Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: i-37 /* t z. J , ;va,Jv2 mai-,7 ,. / 200 amps or less _ 100.70 2
Address: .6 td L L_-, �,r, --7 201 amps to 400 amps 133.56 2
ail-Lim amps to 600 amps 200.34 2
City/State/ZIP: us i)e i t ,7f:,:' 4,,,;,--..,Alf,- r /it- 601 amps to 1,000 amps 301.04 2
Phone:( ) K- ✓` : r Over 1,000 amps or volts 552.26 2
`GGw�i t t>! 27././_...$
/Sir Temporary services or feeders installation,alteration,and/or
Email: f. 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
Branch circuits—new,alteration,or extension,per panel
0 APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
Business name: ivy.ut-Lat, L1 1' above service or feeder fee,
7A2 2
["11-5 INS Feeeach branchcircuit
Contact name: l B.Fee for branch circuits without
Address: J S^� n' service or feeder fee,first 56.18 2
D l& L A-1((Aa.p Nk I- .) Dbranch circuit
City/State/ZIP: a.1 t(jl 'I,-c]"1 O8 Each add'I branch circuit 7.42 2
/ G Miscellaneous(service or feeder not included)
Phone:(F03) 5'5 L—')J,'c.( Each manufactured or modular
67.84 2
{� dwelling,service and/or feeder
Email: to t t,' , c r; t 0_, e �1 t'>6Q ke cD.t A , C ov t- Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
� _ `f y Q 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
S� LE- Industrial plant(1 hr min) 78.18/hr
Email: -21,--1
Inspections for which no fee is 90.00/hr
CCB Lic.: i-41,--1 to U Electrical Lic.: Suprv.Lic.:J1g 0 t.$41. specifically listed('/z hr min)
lELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: G" Subtotal:
Print name: 3eicw Date: t -L 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\Penmits\ELC_PermitApp_ELR_ERE.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 WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 DeQEach Total
3' Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
:►_j 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 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:
❑ 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(V2 hr min)
DIMER WORK ONLY: • ELECTRICAL PEANUT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
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
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017