Permit (116) CITY OF TIGARD ELECTRICAL PERMIT
I ' COMMUNITY DEVELOPMENT Permit#: ELC2019-00587
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/04/2019
6 GARI Parcel: 2S103DB00100
Jurisdiction: Tigard
Site address: 13030 SW 115TH AVE
Project: BOROW Subdivision: None Lot:
Project Description: Reconnect only. Power will be changed from overhead to underground conduit line.
Contractor: Owner: BOROW, HARLAN S
PACIFIC EVERGREEN HOMES LLC
13030 SW 115TH AVE
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 09/04/2019 $67.84
Specifics:
1 ea 12%State Surcharge- 09/04/2019 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codeand all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of iss an.-, or if wor. is suspen.ed for more the 180
days. ATTENTION: Oregon law requires you to follow th- -wJ- -dopted by the Oregon Utility Notificatio (enter. ose 4-s a set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy; he rules or• -ct questions to OUNC by calling 503.;3 7 or :00. •2 •
.
, T1 moi' r
Issued By: r7 2-•�C-� Permi -- -•••• ure:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Applicatio i.--E ,n I OR t)►"l l( I. l 51 ()NI 1
Received
City of Tigard �_ ? 19 Date/B : or ` i,� r!
lig13125 SW Hall Blvd.,Tigard,OR 97223 51. Plan Review
IEla
IC Phone: 503.718.2439Date/B : Related Permit#:
Email: TigardBuildingPermits@Tigard(-g(}o'V `' '• Ready Date/By: illi ® See Page 2 for
I I G A R 1> Inspection Line: 503.639.4175 Notified/Method: `� Supplemental Information
p Im n t vu.0 i?.Lt$ardl- ghv _ ` sem/. PP
TYPE OF WORK PLAN REVIEW
❑New construction 0 Addition/alteration/replacement Please check all that apply(submit Z 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.
❑ I-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 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: I Job site address: I 3030$AJ ((Szl - 10OHP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: ( QQ -0 3 ❑Six or more residential units. occupancy.
I ,6,,/rel 4� ` 0 Recreational vehicle parks.
0 Health-care facilities.
Suite/bldg./apt.#: I Project name: 'RC)(dij 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: FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
40 ek S1- USI /j / j ✓ IKE (with above sq.ft.) 75.00 2
`'� c (�Qg+sC `lam'r t'•' r� �t"� Limited energy,multi-family
`� +/ i�,/ ��G residential(with aboveft.) 75.00 2
G,d Iii s v OP TY O"E5 5<<I �e t�s�-f TENANT
w sq.
ROPERTY OWNER ❑ TENANT Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name: —`y ( 1 200 amps or less _ 100.70 u 2
201 amps to 400 amps 133.56 2
5
Address: ( 0 '��) s (S"'' 401 amps to 600 amps 200.34 2
CA City/State/ZIP: - e L 0 1� • ZZ.� 601 amps to 1,000 amps 301.04 2
Phone:( 7 ( -(p Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: 1.Jf-5 3 0(Z O;.v < Q 440,d t, ej",1✓' relocation
Owner installation:This i/stalfation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease r-, ,or ex •. ge '.in• o ORS 447,449,670,and 70 . 201 amps to 400 amps 125.08 2
Owner signature: 'or, / . . ,j j Date: /y�5 401 amps to 599 amps 168.54 2
❑ APP ICANT ❑ CONTACT PERSON / Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 7 42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit I 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email:
Reconnect only i67.842
CONTRACTOR �_����
Pump or irrigation circle ! 67.84 2
l�usmess name: Sign or outline righting b7.84 —2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: 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:( ) 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.: I Electrical Lic.: I Suprv.Lic.: specifically listed(V hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: _ (p /.Pi
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): k"„i y
Authorized signature: TOTAL PERMIT FEE: '75,,1lc
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\Permits\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:
RESIDRESIDENTIAL WORK ONLY: FEE SCHEDULE
ENTIAL WORK .. :,....._.._.._...»...., ,..,..,W .. Description f Q . Each I Total 1
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
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
n 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(%hr min)
t%.,9 1%114e ct8:17(tOlcoNLY4 'ELECT R1 m,moot. ES ' 1
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
n Clock Systems
LI 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