Permit (2) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2019-00870
T t G A RE) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/18/2019
Parcel: 2S103AA01600
Jurisdiction: Tigard
Site address: 10830 SW WALNUT ST
Project: Edwards Subdivision: ECHO HEIGHTS Lot: 3
Project Description: Adding(2)branch circuits and altering(1)branch circuit for remodel of bathroom,living room,and bedroom.
Contractor: P. DICKINSON ELECTRIC Owner: EDWARDS, LES M AND MARCIA L
20719 SW LIDO CT. 10830 SW WALNUT
ALOHA, OR 97078 TIGARD, OR 97223
PHONE: 503-740-6100 PHONE.
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 12/18/2019 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/18/2019 $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 w k is suspended for more the 180
days. ATTENTION: Oregon requires you to follow t rules adopted by the Oregon Utility Notification Cent . hose are set forth in OAR
952-001-0010 through OAR 01-00 . You obtain a y o e rules or direct questions to OUNC by calling 503.232.1 0 .800. .23 `",-
Issued By: ��rC� � 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 ISE ONE)
Received
City of Tigardiii //•� / /Y
Date/B : A / ling" CSL ��C/
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
_ Phone: 503.718.2439'Pi Date/B : !'1 ' 'r -/ 4(3
Email: TigardBuildingPermits@Tigard-or.gov Ready Date/By: 1111111111111 s See 'age 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 ❑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.
0 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
Multi-familyMaster builderamps for all other installations. buildings.
❑ ❑ 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job Site address: [� N/ i i,eei r .}� S�t
3 0Addition of new motor load of system.
S /h G( I100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: Q Nr 6 ❑Six or more residential units. occupancy.
. �l / .) t`") 90 Recreational vehicle parks.
.1 �" 0Health-care facilities.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
0 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: 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
teQ.mak.) ; 0.tkn'e c o to i- 4,..-1 c3`C 6 b (with above sq.ft.) 75.00 2
/ 'J� 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: L C) 4. M o c c t c— 6- L,'6- 1-a > 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address:
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 0 CONTACT PERSON _Branch circuits—new,alteration,or extension,per 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 56.18 `I G'1 0 2
branch circuit
City/State/ZIP: Each add'l branch circuit ,A 7.42 /y tqz, 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: 1 I)i c.N H66v•• Elle cj'v C 4-H L; Sign or outline lighting 67.84 2
e? 11 5 t� 4' a c s f f Signal iter tiont(s)or limited-energyxens .
Address: r panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: A"(6lA d g 9 "")7d/ 8 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(y OS) )$: ^ 6 /0 0 _Investigation(1 hr min) 90.00/hr
^ 0 2`` ; SCA.5 e ¢ Industrial plant(1 hr min) 78.18/hr
`
Email: '� � .n N.(; - C e W Inspections for which no fee is
CCB Lic.:ao rq 7 Electrical Lie.:C I 70 Suprv.Lic.:60.E 9 s
specifically listed(%hr min) 90.00/hr
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES
r/ Subtotal:
Print name:m S T)'Cy,;LI%S O oN Date: f.))/i I j 9 0 Plan Review Required(25%of permit fee):
/ State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature:
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.
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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
Fee for all residential systems combined: $75.00
Description I Qty. I Each Total 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
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n 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
n 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:
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
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ 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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