Permit (8) `1 II CITY OF TIGARD ELECTRICAL PERMIT
• . ' COMMUNITY DEVELOPMENT Permit#: ELC2019 00698
T I(.1 A li I) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 1 0/14/201 9
Parcel: 2S103BD06100
Jurisdiction: Tigard
Site address: 12712 SW 116TH AVE
Project: Tom-Furnace Install Subdivision: HUNTER'S GLEN Lot: 17
Project Description: (1)branch circuit to reconnect furnace.
Contractor: AC ELECTRICAL CONTRACTOR LLC Owner: WOODRUFF, THOMAS 0&JUDY L
5 CENTER POINTE DR SUITE 400 12712 SW 116TH AVE
LAKE OSWEGO, OR 97035 TIGARD, OR 97223
PHONE: 503-910-3514 PHONE:
FAX: 503-845-9633
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 10/14/2019 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/14/2019 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports(Conditions)
This permit is issued subject to the regulati• s 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 plan-. his permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: O -•• law r-�+'res you to follow the rules adopted by the Oregon Utility No' .tion Center. Those rules are set forth in OAR
952-001-0010 throug • 2-1 a 1;90. ma obtain a copy of the rules or direct questions to OUNC by ca ng 50;.2 2.19:•or 1.800.3 344.
P �
Issued By: �' L/ rails/./jai
_ =_ - Pet milieu Signature:( • \�' ' r_ •
—aa`
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 Y-. l t)lt Ol l lc, l 'l c)\1.1
City of Tigard OCT 2019 Received /llI/!1- I� _ �1/
- Date/B ( /
NI
* 13125 SW Hall Blvd.,Tigard,OR 97223 �Z Plan Review
Phone: 503.718.2439 ��° �� 11
Date/B : IMPINZIMIMIll
Email: TigardBuildingPermits@Tigard-or.ggU1 s ° f fl VE)sO •eady Date/By: Juris: —Page 2 for
TI G A R D Inspection Line: 503.639.4175 Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction j 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.
0 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.
A1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
ampngs.
❑Multi-family ❑Master builder 0 Other: Fire forallother installations. Inbustallation
0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: IJob site address:0_4 S W v ❑Addition of new motor load of system.
T I. ( I Cl 100HP or more. ❑"A„ "E„ 'l_2„ l_3„
City/State/ZIP: c 0 ,�\U"...,1/44.... a \ ❑Six or more residential units. occupancy.
` q � ❑Recreational vehicle parks.
❑Health-care facilities.
Suite/bldg./apt.#: I 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: ariz.....54.44= FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Su division: M I 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
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
V e C<"_,A 4 vt E C Pte: r met c Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone: ( ) 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 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
0 APPLICANT I 0 CONTACT PERSON Branch circuits-new,alteration,or extension, ter panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 1 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 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 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:A C e t e C t. 4 c Cr, Ccb, ,,, 4 c.,& Q`,1 L L, Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: tD 0 ...Vco( Ht? -- panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: 11 \ 7 [� Each additional inspection over allowable in any of the above
ty cS.0.,F x v''s. 0 (` ( -1 6 e_ Additional inspection(1 hr min) 66.25/hr
Phone:(50)3 9f c ,'2 sT 1 t,( Investigation(1 hr min) 90.00/hr
p > eye.,
Industrial plant(1 hr min) 78.18/hr
Email: QC e 1 E,C A.Y\ k C.2.,<,.�\,,,,,,\';i a( L L� �f e.` t 4tL,, CU.t
�� Inspections for which no fee is 90.00/hr
CCB Lic'1_146S78 CL Electrical Lic.: 1 ( Suprv.Lic.:/yy i q S specifically listed('/�hr min)
Suprv.Electric,:q-._.�:. (R�., ,._,,k..... 6;461,/ �- ELECTRICAL PERMIT FEES
p tire,required: \\\ WWWL�
Subtotal:
Print name:V(0 e j\...o 0,.0.-‹ rJ ok t k k,C', Date: C�J/U/ ( 0 Plan Review Required(25%of permit fee):
( l ( State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
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\ELCPermitAppELR_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:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. I Each I Total *
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
n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
7 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)
n Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
n 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('/z hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
y * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n 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