Permit (189) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2019-00532
f C.A R f) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date issued: 08/06/2019
Parcel: 1S134CD03600
Jurisdiction: Tigard
Site address: 11950 SW KATHERINE ST
Project: Baccellieri Subdivision: LERON HEIGHTS NO.3 Lot: 63
Project Description: Adding(3)branch circuits for bathroom remodel.
Contractor: OWNER Owner: BACCELLIERI, FRANCES D TRUST
FRANK' BACCELLIERI 11950 SW KATHERINE ST
11950 SW KATHERINE STREET TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 603-476-4482 PHONE: 503-476-4482
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 08/06/2019 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/09/2019 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 OA -001-0090. You =y obtain a py of the rul- or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
/
Issued By:
` i 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 '? FOR OFFICE USE ONLY
City of Tigard e Received _
9 Date/B : �� ;,_
- 't 13125 SW Hall Blvd.,Tigard,OR 97223 r
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 ; Date/B : Rela>; `' do. S
?/-
Inspection
Inspection Line: 503.639.4175 Ready Date/By: Jnris: H See Page 2 for
TIGARD Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OI WORK,, . PLAN REVIEW
❑New construction ®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 ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or
_ . , ;. - ,, - ' ! 0 Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump.
Installation of 150 KVA or
JOB.SITE INFORMATION AND LOCATION' 0 Emergency system.CIAlargter separately derived
dde
Job#: Job site address: 11950 SW Katherine Street 100HitioPn or ofn
morew motor load of sysem.
0"A","E","1-2","1-3",
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name:Master Bath Electrical ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:SW 121st 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 ft orportion
33.92 1
sq
lP
Switch �ry
es, heated floor DESCRIPTION OF WO Limited energy,residential 75.00 2
electrical (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
W. Renewable Energy ❑ See Page 2
® PROPERTY OWNER I aTENANT = Services or feeders installation,alteration,and/or relocation
Name:Franki Baccellieri 200 amps or less 100.70 2
Address: 11950 SW Katherine Street 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,OR 97223 601 amps to 1,000 amps 301.04 2
Phone:(503)476-4482 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 59.36 1
intended for s. ase = or exch.: .1-_- - core'• : 1.i'S 447,449,670 d 701. 201 amps to 400 amps 125.08 2
Owner signature: �' ' + �� "Date: 5/47 f/4.7 401 amps to 599 amps 168.54 2
Alifill.
or extensionperpanel
' :. ,APPLICAI , .® I CONTACT PERSON''
A.Fee for branch circuits with , , p
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name:Franki Baccellieri B.Fee for branch circuits without /
Address: 11950 SW Katherine Street service or feeder fee,first / 56.18 2
branch circuit
City/State/ZIP:Tigard,OR 97223 Each add'l branch circuit / 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)476-4482 Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:frankideane@gmail.com Reconnect only 67.84 2
`-`CONTRACTOR,
z € __.,; Pump or irrigation circle 67.84 2
Business mime. Sign oro fflTl 1lgtath —lg 67.84 2
A r Signal circuit(s)or limited-energy See Pa e 2 2
dd ess: panel,alteration,or extension. ❑ g
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
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(14 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: :la1.•t r
>-"'..-") ,
TOTAL PERMIT FEE:
Print name: Franki Baccellieri Date: g7(=7 6 7
This permit application expires if a permit is not obtained within 180
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
•Electrical•Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
I ESt EIS TIAL+wOW ONLY: FE}SCHEDULE :ri.
Fee for all residential systems combined: $75.00
Description I Qty. I Each I Total
)' Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
El 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
El Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
El Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
El Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
El 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(%3 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL. PERMIT FEES.
''" 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
El Boiler Controls
El Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
❑ Other:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015