Permit 111 CITY OF TIGARD ELECTRICAL PERMIT
•: COMMUNITY DEVELOPMENT Permit#: ELC2020-00081
T t c A R o 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/06/2020
Parcel: 2S114BA07200
Jurisdiction: Tigard
Site address: 9800 SW COOK CT
Project: Valdez Subdivision: COPPER CREEK Lot: 14
Project Description: Adding(3)branch circuits.
Contractor: R&D ELECTRIC INC Owner: VALDEZ,ANA MD&FRAMIL
PO BOX 868 VALDEZ, FRANCIS S&LILIA ED
MULINO, OR 97042 9800 SW COOK CT
TIGARD, OR 97224
PHONE: 503-679-7987 PHONE.
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 02/06/2020 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 02/06/2020 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. his permit I expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires y"i' t- •/ththe 'ules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 1- . Youfay 40117/ir•rth-eirtiles or direct questions to OUNC by callin .232 1,987 or1. 0.3 .2344.
�f\Js �.
Issued By: q �� , � Permittee Signature: ` _
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application
RFOrrtF
I
City of Tigard 13125 SW Hall Blvd.,Tigard, FEB 202 D •
aattee//B g 6' e o2 � F/
OR 97223 y
114
Plan Review
Phone: 503.71$.2439 Date Byr Related Permit :
Email: TigardBuildingPermits@aTigard-or.gov Ready Date/By: Jam: 21 See Page 2 for
T 1 G A R D Inspection Line: 503.639.4175 Internet: www.tigard-or.gov 'Notified/Method: Supplemental Information
,TYPE OF WORK PLAN REVIEW
0 New construction [Addition/alteration/replacement Please check all that apply(submit 2 sets of plans whtems 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 ❑Commercial/industrial 0 Accessory building less to ground.or exceeds 14.000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑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: ciCgOO SUL" CpcK CJ1 1001W or more. ❑"A","E "t-2","1-3",
City/State/ZIP: V ❑Six or more residential units. occupancy.
y \ `Lctir'� C `L Sl 2 0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: >y\tr \ 0 Hazardous locations. ❑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'l 500 sq.ft_or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
‘ (� r- (with above sq.ft.) 75.00 2
1 l.�, r� V. � CJ h-� �� \ i v Limited energy,multi-family
75.00
residential(with above sq.ft.)
4 C-t c& Qt'r ,�i 564 4' 6' e---e.s. i�` .) Renewable Energy ❑ See Page 2 2
❑ PRO RT O ER �'I ❑ 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 I
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,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 1
Address: service or feeder fee,first 1 56.18 SC— 2
branch circuit
City/State/ZIP: Each add'i branch circuit a_ 7.42 )t-11 `.
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: c Lam { 1e..k_ F,: 1 c_ Sign or outline lighting 67.84 2
1t Signal circuit(s)or limited-energy ❑ Page See 2 2
Address: 1 1 i ,Z` panel,alteration,or extension.
City/State/ZIP:T. (� C Each additional inspection over allowable in any of the above
U Additional inspection(1 hr min) 66.25/hr
Phone:(S.J3) �" . 7� ' Investigation(1 hr min) 90.00/hr
(Ara Industrial plant(1 hr min) 78.18/hr
Email:
�' C.XC.t �; .�t Inspections for which no fee is
CCB Lic.:1-�3 ZJ,'Ci /_ Electrical Lie.:C 3,A. (.Suprv.Lic.:5 „ 5 specifically listed(%hr min) 90.00/hr
6� r1G ' �t`-J ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: r.. Subtotal: 7 i *
Print name: C 4,,- tit) Date: 4;. ,v ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): S-Zjj
Authorized signature: �"< r,�� TOTAL.PERMIT FEE: `7
3-T
y j�j /� This permit application expires if a permit is not obtained within 180
Print name: __v�'� Cy� Date's°"C- g''�.��.� days afte t has been accepted as complete.
'ti � * Number of inspections allowed per permit.
I�Building�PennitsiELC_PermitApp_l;•l.R_EREdoc Rev 10! 17 440-4et5T(l l:'OS/COM/WEB