Permit CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit#: ELC2019-00331
;A It.f7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/16/2019
Parcel: 2S104DD02700
Jurisdiction: Tigard
Site address: 12859 SW RIDGEFIELD LN
Project: Wood Subdivision: MOUNTAIN HIGHLANDS NO.2 Lot: 24
Project Description: Replacing(1)200 amp service panel and adding(2)branch circuits for new bathroom in existing bedroom.
Contractor: AC ELECTRICAL CONTRACTOR LLC Owner: LIBBY&RYAN WOOD
5 CENTER POINTE DR SUITE 400 12859 SW RIDGEFIELD LN
LAKE OSWEGO, OR 97035 TIGARD, OR 97223
PHONE: 503-910-3514 PHONE: 406-891-4553
FAX: 503-845-9633
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 05/16/2019 $100.70
Specifics: amps or less
2 crt Branch Circuits w/Purchase 05/16/2019 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 05/16/2019 $13.86
Electrical
Type of Const:
Occupancy Grp:
Total $129.40
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 o follow the rules adopted by the Oregon Utility Notification Center. T ose rules are set forth in OAR
952-001-0010 through OAR 001-009 ou obtain a copy• he rules off. ect questions to OUNC by calling 503.232.1987 or 1 0.332.2344
Issued By: �� " Permlttee 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 Applicat ` : fi, FOR OFFICE USE O' LA
City of Tigard ecetver ���
13125 SW Hall Blvd.,Tigard,OR 9726 1 G 2019
Date/B : ��� %��
I Plan Review
L.
Phone: 503.718.2439 Date/B : Related Permit#:
Email: TigardBuildingPetmits@TigaaIii
�or ov , Ready Date/By: Juris: 0 See Page 2 for
T I(,A R D Inspection Line: 503.639.4175 tti} ks vawwiv:x4gatial=c rgqv Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction xi Addition/alteration/replacement 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.
11-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.
0 Multi-family ❑Master builder 0 Other:
❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
/ ( / ❑Addition Hof new motor load of system.
Job#: Job site address: r 11-13
Q/ct n l�L{Nz, lo0HP or more.
City/State/ZIP: 7-yep.'i o I. q7�)_3 ❑Six or more residential units. occupancy.
0
/ ( t 0 Health-care facilities. Recreational vehicle parks.
Suite/bldg./apt.#: 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: ��y��, //�/j FEE SCHEDULE
Sin) IC�.t �/,ILI'.IL X S,1 i /�' •I%I/LC-: Description I Qty. I Each I Total i
I I/% !JC �(i'� l New residential single-or multi-family dwelling unit.
Subdivision: 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 WORK Limited energy,residential
y� 75.00 2
/�` " 6d ��1/ a S I /kt `7�[.�C ,(10-W . (with above sq.ft.)
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: Rya, J ,( 200 amps or less / 100.70 /Oa,7d 2
Address: 12 y5' 51-) �/- c>4„,,.�/ 4201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: —.71,4,e/ 3601 amps to 1,000 amps 301.04 2
Phone:( ) / U /!�Z e [�^`44 GfOver 1,000 amps or volts 552.26 2
•
Email:
Temporary services or feeders installation,alteration,and/or
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
APPLICANT 13 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
��A / ` �' A.Fee for branch circuits with /�
Business name: NQ wl C7"'Ct r /1, ,7 GLC above service or feeder fee, Z 7.42 /11V V 2
j [/" l each branch circuit
Contact name: D`,.tA./ 5/-,,�, . B.Fee for branch circuits without
���"'- ��� �J service or feeder fee,first
Address: Z J$0 S /5 J K branch circuit 56.18 2
City/State/ZIP: day / Each add'l branch circuit 7.42 2
C/p p A ��( � Miscellaneous(service or feeder not included)
Phone:(� D0'3) 3 ,(y6 /6 Each manufactured or modular
l l dwelling,service and/or feeder
Email: 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 4-6. F(t c 1174L Sign or outline lighting 67.84 2
/!
Address: Signal circuit(s)or limited-energy
(� ��v X T 27 panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP:
-77/ r U L [ 70`Z Each additional inspection over allowable in any of the above
L / �^ / t Additional inspection(1 hr min) 66.25/hr
Phone:( 703) f(t) 75--14/ Investigation(1 hr min) 90.00/hr
Email: // �/// / Industrial plant(1 hr min) 78.18/hr
lC?('C(,, , c 4 aCl�c,f//6(ya4oa- co'-
Inspections for which no fee is 90.00/hr
CCB Lic. 75,/9 Electrical Lic.• AG( uprv.Lic.: 581 specifically listed(%hr min)
�l'' rdtll /lill l`f ELECTRICAL PERMIT FEES .
Suprv.Elec clan sig ature,required: � �� Subtotal: 115:sy
Print name: /.) 66,,,,-74-0 6a N Lia 1,..-,/4 Date: _/01/ 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized si No. �, �l'�il TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: ' Date: s ! / /if _ days after it has been accepted as complete.
* Number of inspections allowed per permit.I:iBuilding\PennitsiEL _'ermit pp RE.doc Rev 10/26/2017 440-4615T( COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
AE ,E1 1. IAL?V'O.a ONLY h _ s4EDULE' ....
"' Description Qty. I Each I Total I *
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:
❑ 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) 552.26 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)
tOW4EittlAL WD tiEctrtueaa;E r,' ? O
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*
❑ 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_PermitAppELR_ERE.doc Rev 10/26/2017