Permit (142) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT FIPermit#: ELC2019-00158
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 F <' Date Issued: 03/12/2019
Parcel: Tigard A01200
Jurisdiction: Tigard
Site address: 11280 SW 78TH AVE
Project: FOLEY Subdivision: None Lot: None
Project Description: (1)220 amp feeder and(8)branch circuits for addition. 4/8/19:REPRINTED permit to include(7)branch circuits.
Contractor: ROCKY MOUNTAIN ELECTRIC Owner: FOLEY, GREG P
PO BOX 670 11280 SW 78TH AVE
BORING, OR 97009 TIGARD, OR 97223
PHONE: 503-618-9379 PHONE:
FAX: 503-663-6619
FEES
Quantity Description Date Amount
1 ea Services or Feeders-201 to 03/12/2019 $133.56
Specifics: 400 amps
8 crt Branch Circuits w/Purchase 03/12/2019 $59.36
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 03/12/2019 $23.15
Electrical
Type of Const: 1 ea Investigation Fee 03/12/2019 $90.00
Occupancy Grp: 1 ea Investigation 12%State 03/12/2019 $10.80
Surcharge
7 crt Branch Circuits w/Purchase 04/08/2019 $51.94
Service or Feeder
0 ea 12%State Surcharge- 04/08/2019 $6.23
Electrical
Total $375.04
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Gas - d 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 issuce, or if •rk is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notif ,tioyer/-r. hose rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a cop of •ect questions to OUNC by calli • '� 19;. or 1..''.332.2344. )/
Issued By: Permittee Signature: , 9 j.
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.
Etlimmimmmiumo
Electrical Permit Application
REvEIV
City gfTigardFEB 12 2019 I e Rece/11 ived
,p Permit#: 1 .'.'
• 13125 SW Hall Blvd„Ti ard,Olt 97223 -
& �+ flan Review Related Permit Si:Phone: 503.718.2439 Fax: 503.598.1911�l!well(OF TIGARDI>nle/Ity; fa7A7��G (JO
• TIC AL Inspection Line: 503.639.4175 BUILDING niv�srr��+adyl)atc/Ily;
AUK la See Page 2for
�'
Internet: svww.ligvd-ocgm NtiaetVMclhtai: � , Suppkmentai information
TYPE OF WORK PLAN REVIEW
New construction Addition/alteration/replaccnic ` I A ': Plcaaa check n11 that apply/submit 2 sets of plans w/items checked):
Ili Demolition •Other: '---altl�irZ i ❑ Service or feeder 400 0
CATEGORY OF CONSTRUCTION W � 4.011111 antpa or more Building over three
1-and 2-familywhere the available fault current stories.
IN dwelling 0 Contntercial/indust ial El ess,ry building exceeds 10,000 amps at 150 volts
Marinas
in Multi-family Master builder I Other: or and boatyards.
JOB SITE INFORMATION AND LOCATION lessmto ground,other or exceeds 14.s. ❑
_ amps Ole all 'mutilations. Floating
Job#: Job site address: . S W 7 i;h • ' E3Fire pump. �twtng\'
'z
City/State/ZIP:`' (! 9??z.'� 0 Emergency system. Commercial-use
r ❑ agricultural
Addition of new motes buildings
Suite/bldg./apt.#: V Project name: load of
Cross street directions to job site: loot+P or more.
❑ Six or more residential Installation of 150
c G il/V) (5) 5.2.,,,t,-/, y
./ 't,t 1I \ E/ e,Q units. KVAor
Subdivision: . Lot#: / 0 Health-care facilities. system mtalydcnved
/ t
Tax map/parcel#: ❑ Hazardous locations. 1:3
0
6E","1-2","1.3",occupancy.DESCRIPTION OF WORK Service or feeder 600
amps or more,
�e-•_ t PtIDO,Tte. 1 4- be-ElbeYsG�t_ , a s Recreational vehicle
/�l1am�� �W�•.� C'T V Y t \ iV 1 x�M ` parks.
bt t t.,..ES 0 Supply
n PROPERTY OWNER I n TENANT voltage for more than
Name: 600 volts nominal.
FEE SCHEDULE
Address: lawilettan I Qty. L Each r Total I •
New residential single-or multi-family dwelling unit.
City/State/ZIP: Includes attached garage.
/y
Phone:( ) I Fax:( ) 1,000 sq.ft.or less •' 168.54 4
Ea.Win 500 sq.ft.or portion \ 33.92 1
Email: Limited energy,residential
(with above sq.ft,) 75.00 2
Owner installation:This installation is being made on property that I own which is not +
Limited energy,multi-family
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. residential(with above sq.ft.) 7500 2
Owner signature: Date: Page
❑See
Renewable Energy
❑ APPLICANT Z
0CONTACT PERSON $ekes or feeders Installation,alteration,and/or relocation
Business name: 200 amps or less 100.70 2 1
Contact name: 201 amps to 400 amps ( 133.56 !3?,j(y 2
- 401 amps to 600 amps 200.34 2
Address: 601 amps to 1.000 amps 301.04 2
City/State/ZIP: Over 1,000 amps or volts 552.26 ` ,2
Temporary services or feeders installation,alteration,
Phone:( ) I Fax::( ) and/or relocation
200 amps or less 59,36 t 11
Email:
- 201 amps to 400 amps 125.08 2
CONTRACTOR
401 amps to 599 amps 168.54 1 2
Business name: 2.606\Ctf\f�� N) e L -Cr -k, Branch circuits-new,alter on,or extension,per panel
A.Fee for brunch circuits wit
Address: 1c).0 .36.0x 07 D above service or feeder fe, jam' 1- 749 x 7
City/State/ZIP: n ��y--7 .9 each branch circuit �{ 7.42 i,2 A r
S_ t , 0 - 1 !�� B.Foo for branch circuits 7-40/If�{I
Phone:(5037 i % .15•� C� Fax:( ) without service or feeder fee,
first brunch circuit 56.I8 2 a'1 !I
tl L
Email: 'Qb Ll e -E f.%4_ `1"^ Each add'I branch circuit 7.42 2
CCB Lic.: ,5. O Electrical Lic.: 2 4a N eC Suprv.Lic.:/553
Miscellaneous(service feeder not included)
p 5 Euch Etch manufactured or modularular
67.84 2
dwelling,service and/or feeder
feeder
i Suprv.Electrician signature,required:
Reconnect only 67.84 2
Print name: �- atter- kketo$4,e— Date:3 it/Z.,4,11 itI Pump or irrigation circle 67,84 2
Sign or outline lighting67.84 2
Authorized signature:/�Li-i�� Signal circuits}w limited- ❑See Page 2
energy panel,alteration,or 2
Print name: extension, -•
�� �.� Vsj,� I Date:0////2,41/1 Each additional inspection over allowable in any of the above A'
I Uuildinghtmii le.yenitApp_ELA_F.RIt4oe Rev x6/17/2013440-46 ST(I I/OS/COM/WEB „ (51.6 11 i0 • '7)
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CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2019-00158
TfGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/12/2019
Parcel: 1 S 136CA01200
Jurisdiction: Tigard
Site address: 11280 SW 78TH AVE
Project: FOLEY Subdivision: None Lot: None
Project Description: (1)220 amp feeder and(8)branch circuits for addition.
Contractor: ROCKY MOUNTAIN ELECTRIC Owner: FOLEY, GREG P
PO BOX 670 11280 SW 78TH AVE
BORING, OR 97009 TIGARD, OR 97223
PHONE: 503-618-9379 PHONE:
FAX: 503-663-6619
FEES
Quantity Description Date Amount
1 ea Services or Feeders-201 to 03/12/2019 $133.56
Specifics: 400 amps
8 crt Branch Circuits w/Purchase 03/12/2019 $59.36
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 03/12/2019 $23.15
Electrical
Type of Const: 1 ea Investigation Fee 03/12/2019 $90.00
Occupancy Grp: 1 ea Investigation 12%State 03/12/2019 $10.80
Surcharge
Total $316.87
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/O'A3• -001-0090. Y.. .' ...' - opy of the?t les or direct questions to OUNC by callin 5 . 3 19:•1.74i,3322344.
Issued By: Permittee Signature: v\
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.
Erammimminum
EI---ectrical Permit Application RECEIV
City of Tigard FEB 12 2019 Reteived _
hale/liy Permit#: ! -) l _
IN ° 13125 SW Hall Blvd.,Tigard,OR 97223��•►► �/S
_ Phone: 503.718.2439 Fax: 503.598.190orIOF TIGARD I Ian kevlcw
Dale/liy,_ Related Permit N: /4'76-----„E„)age tK.—MAO
ins tion Line: 503.639.4175 BU'�® (�G ' �(� L
Ti G A 12 D ndy I>mc/I ly: hurls: ®See Page 2 far
Internet:II
wsvw.ligard-or.gov Notilicd/Mclh,slt Supplemental Information
TYPE OF WORK PLAN REVIEW
New construction
r� Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
U Demolition • Oilier: ❑ Service or feeder 400 0
CATEGORY OF CONSTRUCTION amps or more Building over three
1-and 2-familydwelling �''`) where the available fault current stories.
14 g l_.I Commercial/industrial ❑Accessory building exceeds 10.000 amps at 150 volts 0
Marinas
_. Multi-family II Master builder I Other: or and boatyards.
JOB SITE INFORMATION AND LOCATION less to ground,or exceeds 14.000
amps for all other installations. ❑ Floating
Job#: Job site address: Z'6,# Stti1 7:'"x I C ElFirepump. O iwings.
City/Stale/ZIP:` ' , ,fir r - 30 F.mergencysystem. Commercial-use
Suite/bldg./apt.#: Project name: load❑
Addition of new motor agricultural
buildings.
Cross street/directions to job site: i00llP 100tIPormore. 0
0 Six or more residential Installation of 150
units. KVA or
Subdivision: I Lot#: ❑ Health-care facilities, larger separately derived
system.
Tax map/parcel#: 0 Hazardous locations. 0 "A",
❑ Service or feeder 600 E","1-2","1.3",occupancy.
DESCRIPTION OF WORK ❑
amps or more.
' �MtA/4 P��._>rrAc•() oocr ,f Recreational vehicle
//l�am�
l J V i • '" `; parks.
^ ❑ Supply
I I PROPERTY OWNER ' n TENANT voltage for more than
Name: 600 volts nominal.
FEE SCHEDULE
Address: Description J Qty. 1 Eaeb I Total 1 •
New residential single-or multi-family dwelling unit.
City/State/ZIP: Includes attached garage.
Phone:( ) I Fax:( ) 1,000 sq.ft.or less ` 1611.54 4
ha.add'I 500 sq.ft or portion 33.92 1
Email: Limited energy,residential
(with above sq.R.) 7500 2
Owner installation:This installation is being made on property that I own which is not Limited energy,multi-family
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. residential(with above sq.ft.) 75.00
Owner signature: Date:
Renewable Energy 0 See Page
❑ APPLICANT 1 0 CONTACT PERSON 2
Services or feeders installation,alteration,and/or relocation
Business name:
200 amps or less 100.70 2
Contact name: 201 amps to 400 amps (12133.56 / 10 2
401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps _ 301.04 2
City/State/ZIP: Over 1,000 amps or volts 552.26 2
Temporary services or feeders Installation,alteration,
Phone:( ) I Fax::( ) and/or relocation
Email: 200 amps or less 59.36 I
CONTRACTOR 201 amps to 400 amps 125.05 2
401 amps to 599 amps 168.54 2
Business name: 2.606\C t1/4�TN) eLezre.A.L. Branch circuits—new,alter on,or extension,per panel
�. � r D A.Fee for branch circuits re
Address: tp
above service or feeder fe,
City/State/ZIP: 15Ctk rr t et - L7CSo Faeh brunch circuit 7.42 2
�J l B.Fee for branch circuits
Phone:(503 (o( % 15 7/ Fax:( ) without service or feeder fee, 56.18 2
first branch circuit
Email: ► IX LIS Each;41'1 branch circuit 7.42 2
I . :I Miscellaneous(service or feeder not included)
CCB Lie.: '5'710 Electrical Lie.: z fc Suprv.Lic.:1553 5 Each manufactured or modular
Suprv.Electrician signature,required:
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
Print name: T Z-da3Xr k..6,0$4,--- Date:3/I - ZO 11 Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
Authorized signature:)240, ..-i Signal circuil(s)or limited- ❑ See Page 2
!—� � penergy panel,alteration,or 2
Print name: JL " 1,_ cif /
_ Date: 1/ �/ extension,
4 �s'� Each additional inspection over allowable in any of the above
WIlaildina'PermitslEL(i_PermitA ELR_ERlidoc Rev 06/17/2015 430-46 5T(11/05/COM/WCU C
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AdditionalInspcction(1 hr min) 6625/hr
Investigation(I hr min) • 90.00/hr
Industrial plant t I hr min) 78.18/hr
Inspections for which no fee is 9000/hr
s •cificaily listed(%,hr min
ELECTRICAL PERMIT FEES
Subtotal: 393.444
n Plan Review Required(25%of permit
fee): State surcharge(12%of permit fee):
TOTAL PERMIT FEE: 34 3.4(t
This permit application expires if a permit is not obtained within ISO days after it has been accepted as
complete.
• Number of inspections allowed per permit.
•
•
t
114.,:.1.1v Newts I IC Pams.yp.I Lit tat s. ft"O.11:'015
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