Permit (131) IIIICITY OF TIGARD ELECTRICAL PERMIT
I ' COMMUNITY DEVELOPMENT Permit#: ELC2019-00617
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/19/2019
Parcel: 1 S 134CB01800
Jurisdiction: Tigard
Site address: 12130 SW SUMMER ST
Project: Lamb Subdivision: SUMMER HILLS PARK Lot: 21
Project Description: (3)branch circuits for master bedroom and new bathroom.
Contractor: OWNER Owner: LAMB, RICHARD PIERCE
RICHARD &JANNA MAE LAMB BOREN,JANNA MAE MARTIN
12130 SW SUMMER ST 12130 SW SUMMER ST
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 541-840-5537 PHONE: 541-840 5537
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 09/19/2019 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/19/2019 $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 0 952-001-0090. You may obtain a.•u.,—Ie rules or direct questions to OUNC by calling 503.232: 87 or 1. 32.2344.
Issued By: . — — _sem Permittee Signature: r" -�-
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent. r
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 RECEIVE
[OR 01 l I( I. l ti I. t)\1.1
City of Tigard Date/Bed: ® EZIMMI
1111 _ "I 13125 SW Hall Blvd.,Tigard,OR 97223 SEP 19 2019 Plan Review
Phone: 503.718.2439 Date/B : Related Permit#: rte - 3 i` 4
Email: TigardBuildingPermits@Tigard-or.gov TIGARD Ready Date/By: Jam: ® See Page 2 for
-1 I L.,1 R D Inspection Line: 503.639.4175 Internet: w �'Q��r v Notified/Method: Supplemental Information
RI I f71N1-a LIIVISIO'..
TYPE OF WORK PLAN REVIEW
O New construction ig 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 9 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
!g -and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 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#: I Job site address: 1 Z1 3C7 S;.t) uv'vitlbtCeir 5} 100HP or more. ❑"A","E","1-2","1-3",
�
El Six or more residential units. occupancy.
City/State/ZIP: o YtQ 1 O i f 1Z
0Health-care facilities. 0 Recreational vehicle parks.
"
Suite/bldg./apt.#: I Project name: /..., ],., 0 Hazardous locations. 0 Supply voltage for more than
Qr ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: i I s t ...0 Jvj Safrn ow s4- FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: //// rL I Lot#: 24 Includes attached garage.
SG��i/l�Y S 1,000 sq.ft.or less 168.54 4
Tax map/parcel#: I S j 324 C o 01 f3Q0 Ea.add'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
�'�/ `- / 1 gad
(with above sq.ft.) 75.00 2
. r,-4.4/10/7?0/7 A i,_40- Q<��AN g/�' 4tnur'441/4/�ii-ti Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
PROPERTY OWNER I 0 TENANT Renewable Energy 0 See Page 2
Services or feeders installation nit ation and/or relocation
Name: 02,/K61 Ma, a?h 200 amps or less - 100.70 2
�-i i -50 s`!J e 0.1v 51. 201 amps to 400 amps 133.56 2
Address: ✓' -
401 amps to 600 amps 200.34 2
City/State/ZIP: // clpzi OE '7 Z Z 3 601 amps to 1,000 amps 301.04 2
Phone:(54i ) eitel Q —5-S 3 1 Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: '14,44 ,4siae, af 0 44Oi I . („Or,.7 relocation
Owner installation:This installation is 13Jipi made on property that I own which is not 200 amps or less 59.36 I
intended for sale,lea - rent,or • change,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: /� ;��.-
. -..-"... --4------ Date: 9//i:V/f 401 amps to 599 amps 168.54 2
' .� Branch circuits-new,alteration,or extension,per panel
O! ' 'PLICANT 0 CONTACT PERSON
A.Fee for branch circuits with
Business name: Lf'7 i�j��� above service or feeder fee,
7.42 2
C/ ` each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first ` 2
Address: branch circuit miry
56.18 5Zr ,ti;
l l
City/State/ZIP: Each add'l branch circuit 7.42 ,r y 2
Miscellaneous(service or feeder nalincluded)
Phone:( it// ) ego --,s.-5 s .._ Each manufactured or modular 67.84 2
dwelling„service and/or feeder
Email: J L/N N A 446,Le kf:✓t°H Q3 y,f/v,/-ce/1// Reconnect only 67.84 2
coNTRAcropu Pump or irrigation circle 67.84 2
usmess nme:r y !� Ott7A/trt -._ . '•-- � w
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:(61 1 ) e/40 -GJ - 7 Investigation(1 hr min) 90.00/hr
Email: { Industrial plant(1 hr min) 78.18/hr
Jh 'mete � ,gvfito✓t �ltil Inspections for which no fee is
CCB Lic.: Electrical Lie.: �/ Suprv.Lic.: specifically listed('V hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 7!.(
Print name: Date: 0 Plan Review Required(25%of permit fee):
/ ,, State surcharge(12%of permit fee): r. S
Authorized signature: TOTAL PERMIT FEE: -
This permit application expires if a permit is not obtained within 180
Print name: Date: Cy/V days after it has been accepted as complete.
Q G(2 �� * Number of inspections allowed per permit.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
tion I Fee for all residential systems combined: $75.00 Rn en wable electrical energy systemsI EaTotal
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n 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('%hr min)
COMMERCIAL WORK 0**:, .,, . `; ..E SL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
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_PermitApp_ELR_ERE.doc Rev 10/26/2017