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Permit CITY OF TIGARD ELECTRICAL PERMIT N41 '! '' COMMUNITY DEVELOPMENT1 Permit#: ELC2019 00803 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/12/2019 Parcel: 2S 111 CC 15500 Jurisdiction: Tigard Site address: 10045 SW HIGHLAND DR Project: KEEFE Subdivision: SUMMERFIELD NO.4 Lot: 206 Project Description: Panel replacement. Contractor: A C ELECTRIC INC Owner: KEEFE, R BARRY& FRANK] 18820 SHENANDOAH DR 10045 SW HIGHLAND DR OREGON CITY, OR 97045 TIGARD, OR 97224 PHONE: 503-650-0052 PHONE: FAX: 503-650-0052 FEES Quantity Description Date Amount 1 ea Services or Feeders-200 11/12/2019 $100.70 Specifics: amps or less 1 ea 12%State Surcharge- 11/12/2019 $12.08 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 Required Items and Reports(Conditions) 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„ rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090.-0 You may obta a copy of the rules or direct questions to OUNC by calling 50.. 1947 or 1.800.332.234 . Issued By: / /..— Permittee Signature: w I 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. ciiiiiimmommi. Electrical Permit Application ��e City of Tigard i"a- (y q0 Received / +/) ;1 l� L r ? / Permit#: r / t/`� � Date/By: �� / 13125 SW Hall Blvd.,Tigard,OR 97223 C l N �,)P an Review Phone: 503.718.2439 O,c-c\(j,P� te/gy, Related Permit#: Email: TigardBuildingPermits@Tigard-or.gov r,-0 ead Date/By: .turfs�: —' age `' or T I G A K D Inspection Line: 503.639.4175 Internet: www`H� 1 v, Notified/Method: - Supplemental Information TYPE OF WORK AV\'� PLAN REVIEW ❑New construction / Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more 0 Building over three stories. 0 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. -and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 El Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: 0 Fire pump. El Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION (� ❑Emergency system. larger separately derived Job#: Job site address:/OO(5. f D ` ��L r/ V I\ r ❑Addition of new motor load of system. r w l f Il XAiY�D� loomor more. ❑"A","E","1-2","]-3", ❑Six or more residential units. occupancy. City/State/ZIP: ❑Recreational vehicle jet}2—ee �ctT� El Health-care facilities. parks. Suite/bldg./apt.#: Project name: ❑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: a..� Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential - _ © (with above sq.ft.) 75.00 2 7. �j-P ��n -- ��-�`✓v A�LLimited energy,multi-family G S'L residential(with above sq.ft.) 75.00 2 Renewable Energy ❑ See Page 2 0 PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: /""eCylr 200 amps or less I 100.70 � 1G3 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 Branch circuits—new,alteration,or extension,per panel 0 APPLICANT 0 CONTACT PERSON 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 service or feeder fee,first Address: branch circuit 56.18 2 City/State/ZIP: Each add'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: /9� "�� p Sign or outline lighting 67.84 2 j, =�C 0i1 Signal circuit(s)or limited-energy Address: ff' fj t panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: 4:,-, /� q J� (� Each additional inspection over allowable in any of the above `� * / / [ Additional inspection(1 hr min) 66.25/hr Phone:(6 73) '' ,C Investigation(1 hr min) 90.00/hr Email: J /��u� /y f.? ��I Industrial plant(I hr min) 78.18/hr YAK ^l,V v 9tn#4 t !✓ ` Jr) Inspections for which no fee is 3-(,8- specifically listed(%z hr min) 90.00/hr CCB Lic.: Electrical Lic.: / Suprv.Lic.: 1� �r �/� ? t� ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: 2 Subtotal: Print name: J '- �4�/,!`l, Date: -/— 0 Plan Review Required(25%of permit fee): 4 State surcharge(12%of permit fee): ��_C _:6 Authorized signature: -- TOTAL PERMIT FEE: j�} This permit application expires if a permit is not obtained within 180 Print name: R, f�gyp``n V 1) Date:H—j .' * Number of inspections allowed per permit. L\Building\Permits\ELCPermitApp_ELR_ERE.doc Rev 10/26/2017 440-4615T(11/05/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. I Each I Total I * 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 A• udio and Stereo Systems* 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 with OAR 918-309-0040) 552.26 2 n Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* 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: 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: n Audio and Stereo Systems ❑ Boiler Controls n Clock Systems n Data Telecommunication Installation n Fire Alarm Installation n HVAC n Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical n Nurse Calls n Outdoor Landscape Lighting* n Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations Ii\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017