Permit (19) CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT
71
Permit#: ELC2019-00376
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/05/2019
Parcel: 1S134BD08400
Jurisdiction: Tigard
Site address: 11003 SW 115TH AVE
Project: Prentice Subdivision: PENN LAWN ESTATES Lot: 12
Project Description: Replacing(1)breaker box and adding(16)branch circuits.
Contractor: OWNER Owner: PRENTICE, PATRICK C
PAT PRENTICE MCKEE, CHERYL A
11003 SW 115TH AVE TUOMI, JEFF
TIGARD, OR 97223 11003 SW 115TH AVE
TIGARD, OR 97223
PHONE: 503-628-9553
PHONE: 503-628-9553
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 06/05/2019 $100.70
Specifics: amps or less
16 crt Branch Circuits w/Purchase 06/05/2019 $118.72
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 06/05/2019 $26.33
Electrical
Type of Const:
Occupancy Grp:
Total $245.75
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 ules are set in OAR
952-001-0010 through OAR 9 -001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.844. Y
Issued By: 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 E
City of Tigard CEIV—` Received [ C L��,,.>,
l I ( -� Permit#: v — (3CS
II
13125 SW Hall Blvd.,Tigard,OR 97223 JUN m Q�J PlanRevrew ��
' C Phone: 503.718.2439 Fax: 503.598.1960 J Date/By: Related Permit#;
I f G K<7 Inspection Line: 503.639.4175 Ready Date By: i loris: H See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method:1,2�St\Lk .5\7Supplemental Information
DING DIVISION -( ksCL*\• (�
, ,. _ k_ �v ., m.w,.-.i . .,, .. 4. -.. n..=_ ,• r as
❑New construction Addition/alteration/replacement Please check all that apply(submit a sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
0 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.
Dgi 1-and 2-familydwellingCommercial/industrialless to ground,or exceeds 14,000 0 Commercial-use agricultural
0 0Accessory building
Multi-familyMaster builderOther: ampsireforallother installations. Inbustallation
gs.
❑ ❑ 0 0Fire pump, ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address: i i op-3 Sj„f I t 5-41, /9 100HP or more. ❑"A","E","l-2","1-3",
❑Six or more residential units. occupancy.
City/State/ZIP: K q r� 7 ' ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: �% Project name: 0 Hazardous locations. 0 Supply voltage for more than
oro,
i�t0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: sty of(h �o4Q FEE SCHEDULE
Description I Qty. I Each I Total i *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: 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
"` .I+WOE Limited energy,residential 75.00 2
f ( (with above sq.ft.)
` (:�M�/l� U�Q�r ( x Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
PRQPERTY OWNER 0 1'ENAN'IRenewable Energy 0 See Page 2
a`Services or feeders installation,alteration,and/or relocation
Name: RI- i°1- f i c6 200 amps or less 1 100.70 '00.70 2
Address: l /
f00j S ✓ I/
1s'�l A,VC 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: T{ a f.(/ 0 e. 9,)22.-3 601 amps to 1,000 amps 301.04 2
Phone:(503 ) G Z 0—9 SS 3 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: ((herrn f(ce..e M c43-(.AeT relocation
Owner installation:This installatio is being mad n property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or ange, c ng to ORS 447,449,6700,end 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: S/03//ci 401 amps to 599 amps 168.54 2
APPLIcI 0 CONTACT PERNoN Branch circuits-new,alteration,or extension,per panel
KA.Fee for branch circuits with
Business name: above service or feeder fee,
P each branch circuit '� 7.42 J' /72 2
Contact name: en(y' B.Fee for branch circuits without
Address: - /�Il+ service or feeder fee,first 56.18 2
�i 001 SL/ H / il/e branch circuit
City/State/ZIP: "ti-r rj Oa ri 722 3 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(03) 62g- /53-3 Fax: :( ) Each manufactured or modular
r dwelling,service and/or feeder 67.84 2
Email:
1G4 'enf>'ct' e tc�,-C9S-'.tic1 Reconnect only 67.84 2
.., «r *5t,s4,w e ,-.rpt F„ .r.,x. ,,a1iirx:..4s;,4 Pump or irrigation circle 67.84 2
Business name: Cx.), c�— Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
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
Industrial plant(1 hr min) 78.18/hr
Email:
Inspections for which no fee is
l listed(V2 hr min) 90.00/hr
specifically CCB Lic.: I Electrical Lic.: I Suprv.Lie.: '
Suprv.Electrician signature,required: Subtotal: Zrq, 42.
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 26.3 3
Authorized signature: TOTAL PERMIT FEE: ?Lis-,-7s
'0.7
� This permit application expires if a permit is not obtained within 180
Print name: 4-/ I/o at, Date: ..)70j/r1 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PemritApp_ELR_ERE.doc Rev 06/17/2015 440-46151(11/05/COM/WEB