Permit (4) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2019-00871
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/18/2019
TIGARD g Parcel: 2S102DC00400
Jurisdiction: Tigard
Site address: 9265 SW EDGEWOOD ST
Project: Blauer Subdivision: EDGEWOOD Lot: 16
Project Description: Altering(2)branch circuits for furnace and A/C.
Contractor: OWNER Owner: BLAUER, MARC
MARC BLAUER 9265 SW EDGEWOOD ST
9265 SW EDGEWOOD TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-953-0969 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 12/18/2019 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/18/2019 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 ru adopted by the Oregon Utility Notification Center. Those�rules' are • in OAR
r
952-001-0010 through OAR 9 -00 -0090. You may o in a copy or direct questions to OUNC by callin 50 .23/.1987 or 1.800.
or l71 /A�
Issued By: /�i �C Permittee Signature: /t \
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 503.639.4176 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
City of Tigard Received / /1A1/� ��" �0` / />7 7/
Date/By.
Pe
13125 SW Hall Blvd.,Tigard,OR 97223 s 4 Plan Review111
m �y-, ,,�� 094/S0
Phone: 503.718.2439 Date/By:
Email: TigardBuildingPermits@Tigard-or.gov Ready Date/By: tris: I ® See Page 2 for
TICiARD Inspection Line: 503.639.4175 Internet: www.tigard-or.gov Notified/Method: Supplemental Information
e. .: 'lT,0 '..w'i,-74-1, TYPE OF WORKst- PLAN REVIEW .,, ,, . .,„ 4,
❑New construction 0 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 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.
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
Multi-familyMaster builderOther: amps for all other installations. buildings.
❑ 0 0 ❑Fre pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: I Job site address: 7AG �� i/J ❑Addition of new motor load of system.
Ci(�J-U-��/ 100HP or more. ❑«A» «E» «1.2»«1.3»
City/State/ZIP: 7- 1, ?u- J� 0 Six or more residentialcies. units. Recreational
occupancy.
t/vL- � _) El Health-care facilities. ❑Rrevehicle parks.
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: I FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 2 1, a D C 4 0 4 O 0 CR �6 4 g )I ( E1, a d'lsq.5 or less 168.54 4
I Ea..ad500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK ;z- .i.. .t-, / I I Limited energy,residential
P rr(ta fa C i /4 C hook k up (with above sq.ft.) 75.00 2
f L ILimited energy,multi-family 75.00 2
residential(with above sq.ft.)
PROPERTY OWNER I ❑ TENANT I I Renewable Energy 0 See Page 2
Services or feeders installations alteration,and/or relocation
Name: Ail 0 Y''(✓, 131 A 1,p'e rI 1200 amps or less 100.70 2
Address: qC.c 'IA) TQ,>'e_tA.A _)2U Cl °N4 I 201 amps to 400 amps 133.56 2
1401 amps to 600 amps 200.34 2
'
City/State/ZIP: i :v-d 0 IL / q-7 2-2, I 1601 amps to 1,000 amps 301.04 2
Phone:(5)-- q J 1 - Oq g I Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: l a. 570 ,'S LAI G praiA ,w a f I, c U I I relocation
Owner installation:This installation is b iTrg lade on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or et drt e, ding to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: r.!wi q 401 amps to 599 amps 168.54 2
0 APPLICANT I ❑ CONTACT PERSON . I I Branch circuits-new,alteration,or extension,per panel
/� A.Fee for branch circuits with
Business name: SIFT as A LOUR I above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: I service or feeder fee,first 56.18 2
branch circuit O`.
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 ' ,r' I I Pump or irrigation circle 67.84 2
Business name: I 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: I Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) I Investigation(1 hr min) 90.00/hr
Email: I Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
90.00/hr
CCB Lic.: I Electrical Lic.: Suprv. Lic.: specifically listed('/z hr min)
ELECTRICAL PERMIT FEES , '`'VZ
Suprv.Electrician signature,required: I Subtotal:
Print name: Date: I 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
•Authorized signature.1AJtS ,�� ' I TOTAL PERMIT FEE:
t:J' _� ' This permit application expires if a permit is not obtained within 180
Print name: l -Q V� I Date: 1 b/1 I I days after it has been accepted as complete.
- - ` * 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
I Description I Qty. I Each I Total I * I
Fee for all residential systems combined: $75.00 I 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* I 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 G• arage Door Opener*
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
n H• eating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* I 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:
n 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 ONLY: I 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 A• udio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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