Permit CITY OF TIGARD ELECTRICAL PERMIT
1111
�. COMMUNITY DEVELOPMENT Permit#: ELC2019-00836
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/02/2019
Parcel: 1 S133DD01100
Jurisdiction: Tigard
Site address: 11769 SW 129TH PL
Project: SEGUIN Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 50
Project Description: Adding(3)branch circuits.
Contractor: HARBOR NORTHWEST ELECTRIC LLC Owner: SEGUIN, SHAWN C
1404 NE 17TH AVE VELEZ,WANDA
BATTLE GROUND,WA 98604 11769 SW 129TH PL
TIGARD, OR 97223
PHONE: 503-358-8723 PHONE.
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 12/02/2019 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/02/2019 $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 yo to foil th rules adopted by the Oregon Utility Notifi ion C ter. Those rules are set forth in OAR
952-001-0010 through OAR 952-4 r,090 ou obta of the rules or direct questions to OUNC by calling 5 232.1.9 7 or 1.800.332.2344.
•
Issued By: ,. Permittee Signature:
OWNER INSTALLATION ONLY l 4/ 7`
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. I SE 0y1.1
'PICity of Tigard Received ��
Date/B : % A ,Mir �i' . I
• 13125 S W Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Date/B : r �ilifir�l��iAill
T I G A K D Email: TigardBuildingPermits@Tigard-or.gov Ready Date/By: Juris: FaSee Page 2 for
Inspection Line: 503.639.4175 Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction gj Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more ❑Building over three stories.
0 Demolition El Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
8-1-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 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: I Job site address: 7c3 ❑Addition of new motor load of system.
Z3tAi �) 100HP or more. ❑
City/State/ZIP: (( 2 ❑Six or more residential units. occupancy.
f oY CY )c ' Cl 7 ZZ J 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: tJ I Project name: 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
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
AlaA `` '' f` 1� �� (with above sq.ft.) 75.00 2
0.,.) 0-CtCstx�'S 1 bcin +iun ) �. �; n, a ct,c", 'S Limited energy,multi-family 75.00 2
'7 �i S residential(with above sq.ft.)
t 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,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
Address:
service or feeder fee,first i 56.18 So 4E) 2
branch circuit
City/State/ZIP: Each add'I branch circuit 62. 7.42 J.y-2_-. 2
Miscellaneous(service or feeder not included)
Phone:( ) Each manufactured or modular
dwelling,service and/or feeder
Email: 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: aG.Y 6Y L ,} eei><(C- ) L.L.C. Sign or outline lighting 67.84 2
W' Signal circuit(s)or limited-energy
Address: i3 4.0'1 � �-�
Q 1 �►_t�f /J� �D panel,alteration,or extension. 0 See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP: . IL. C'i,6 4 J.J 9't
Z ) l lg 1 t Additional inspection(1 hr min) 66.25/hr
Phone:( 3) 358_ ,.T 2:2 Investigation(1 hr min) 90.00/hr
�( J �]/ Industrial plant(1 hr min) 78.18/hr
Email:
...
50 � g 4:,.\ . L zyk,�' k ` \ '- Inspections for which no fee is 90.00/hr
CCB Lic.: Ica i�(0 lectrical Lic. C 6- Suprv.Lic.: 5( 9 s specifically listed CA hr min)
Suprv.Electrician signa ELECTRICAL PERMIT FEES re,required: :—f Subtotal:
1 Yl Lr
A�Print name: / pY Date: �/Z_OZ ❑Plan Review Required(25%ofpermitfee):
s 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.
t:\Building\Permits\ELC_PermitApp_ELRERE.doc Rev 10/26/2017 440-4615T(I 1/05/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. L Each j Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
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:
n B• urglar 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
with OAR 918-309-0040) 552.26 2
n H• eating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
n V• acuum 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(1/2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75•00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n C• lock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ L• andscape Irrigation Control*
n Medical
n N• urse Calls
n O• utdoor Landscape Lighting*
n P• rotective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017