Permit CITY OF TIGARD ELECTRICAL PERMIT
I ' COMMUNITY DEVELOPMENT Permit#: ELC2019-00776
T'GA R..D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/31/2019
Parcel: 2S 104AD03504
Jurisdiction: Tigard
Site address: 12800 SW WALNUT ST
Project: Ornelas Subdivision: None Lot: None
Project Description: Replacing 200 amp service panel.
Contractor: FOREFRONT ELECTRIC Owner: JEREMY ORNELAS
16549 SE ALDER CT PO BOX 23966
PORTLAND, OR 97233 PORTLAND, OR 97281
P
PHONE: 506-840-7088
HONE: 503-881-4593
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 10/31/2019 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 10/31/2019 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports(Conditions)
j
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes - d all • OF
plicable 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, if •rk spended for more the 180
days. ATTENTION: Oregon law requires you to f w the rules adopted by the Oregon Utility Notification Center. hos les are set forth in OAR
952-001-0010 through OAR 52-001-0090. Y may o n a y of the rules or direct questions to OUNC by calling 503.232.1987 or .800.3344.
Issued By: Permittee Signature: �e
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 Foil OFFICE Csl:ONLY
INCity'of Tigard rW.MME re i 1:Ci` ---0G77
13125 SW Hall Blvd.,Tigard,OR 97223 8 1
I Phone: 503.718.2439 Related Permit a:
Email: TigardBuildingPennits@Tigard-or.gov Ready Date:By: lava ® See Page 2 for
i IChARI) Inspection Line: 503.639.4175 Internet: www.tigard-or.gov Notified.Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
0 New construction to Addition/alteration/replacement l'Icase check all that apply(submit 2 sets of plans ix/items checked):
❑Service nr 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 ❑Floating buildings.
less to ground,or exceeds 14,(1(10 0 Commercial-use agricultural
NI I-and 2-family dwelling Q Commercial/industrial (11 Accessory building
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑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.
12��
Job#: Job site address: O c{_] i` iL1 u- S4 l oom'or more. ❑ A , t h-2 . 1_' ,
0 Six or more residential units. occupancy.
City/State/ZiP:17 4f A 0R g722?J ❑I Ica lth-care facilities. 11 Recreational vehicle parks.
Sultebidg-/apt.#: Project name: ❑I latardous locations. 0 Supply voltage for more than
`��'' 0 Service or feeder 600 amps or more- 600 volts nominal.
Cross strecddireetions to job site: FEE SCHEDULE
Deveript inn I ohs. I Each i Total I e
New residential single-or multi-family duelling unit.
Subdivision: l.ot#: Ind)udes attached garage.
Tax map/parcel n: 1.000 sq.Il.or less 168.54 I I 4
Ea add'I 500 sq.II. or portion 33.92 ]
DESCRIPTION OF WORK
Limited energy,residential 75.00 1 2
Painc.-1 Swa? (with shove sq.R.)
l.imted energy,multi-family 75.00
residential(with above sq.n.)
PROPERTY OWNER ❑ TENANT Renewable Energy' ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name: JerCvy1,i Q ftine. s 200 amps or less j 100.70 2
Address: '?.Q. a U.y• z 3 9 to(p 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Qt`�-\Gxn•c� Q q 12g� 601 ampsto I n00amps 301.04
Phone:(�y3) evO-7c)$0 Os er 1,000 amps or Botts 552.26 '_
D Temporary services or feeders installation,alteration,and/or
Email. iQfYNn%,/ Q., S0,IMSOtl7GOYISv 1t/tnyy .GOWi relocation
Ownelinstallatiotl:This installation is being made on property that i own which is not 200 amps or less 59.36 1 1
intended for sale,lease,rent,or exchange.according to ORS 447,449,670,and 701. 201 amps to 400 amps I25.05 i 2
Owner signature: Date: 401 amps to 599 amps 1 I 168.54 I 12
0 APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: SC*,,,,,` q at=V e above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first
Address: branch circuit 56.18 _
City/State/ZIP:
Eachadd'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Each manufactured or modular 67.84 2
dwelling,service and'or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: ose cfo vt-Ir C. let-4 ttG L L C Sign or outline lighting 67.84
1 Signal circuit(s)or limited-energy
Address: I (44/q SE A►tier Or panel,alteration,or extension. ElSee Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP:Po r 1,..VI v‘ ...._ (?. co 23 3 Additional inspection(1 hr min) 66.25/hr
Phone:(yam 3) e 8( - L(^S 7 3 f Investigation(I hr min) 90.00/hr
Email:(IIcySGw«Frctn1-ekcJ•(lL[lc.COM Inspectiolslfnt nhichhr no 78.18!ht
i Inspections for no fee is 90.00/hr
CCB Lic.:Z 2 S(e1 Z Electrical Lie.: [(yy q Suprv.Lis..: 6 373 5 specifically listed('i hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: / Subtotal:
Print name:RI`el G-a !la 1 .,e� Date: /D/3N/9 0 Plan Review Required(25%of permit fee):
777 State surcharge(12%of permit fee):
Authorized signature: 1/ /�
TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within ISO
Print name: '�t ke.i ' //G9ti Q/3
er Date: � 0 f 7 4 days after it has been accepted as complete.
• Number of inspections allowed per permit.
l4BuitdingWPamits'ELC PermitApp_ELR_ERE.doc Rev 1026,2017 440-1615 T(11'05 C061'WEn