Permit (2) CITY OF TIGARD ELECTRICAL PERMIT
11111
I. ' COMMUNITY DEVELOPMENT Permit#: ELC2020-00016
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/13/2020
A R ID9 Parcel: 1 S135DB10500
Jurisdiction: Tigard
Site address: 11090 SW 95TH AVE
Project: KASINGER Subdivision: ASHBROOK FARM Lot: 22
Project Description: Replacing(1)service panel and(10)branch circuits.
Contractor: R P ELECTRIC Owner: KASINGER, STEVEN
20582 SE HELZER WAY 11090 SW 95TH AVE
DAMASCUS, OR 97089 TIGARD, OR 97223
PHONE: 503-268-7458
503-661-4972
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 01/13/2020 $100.70
Specifics: amps or less
10 crt Branch Circuits w/Purchase 01/13/2020 $74.20
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 01/13/2020 $20.99
Electrical
Type of Const:
Occupancy Grp:
Total $195.89
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 jalr oche applicab 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, o if work s suspe ed for more the 180
days. ATTENTION, Oregon law requires t f llow the r s adopted by the Oregon Utility Notification Center. Th a rule are set forth in OAR
952-001-0010 through OAR 95 -0090 may in a copy e rut r direct questions to OUNC by 5 .23 .1,987 or 1.8 .332.23
Issued By: � Permittee Signatu ra ._�---'-"
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 503.639.4176 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 OK ICE i SE ONt.l
City of Tigard ReceEl rn oLJ,ZC'- 0(,/ e_Date/Ely:Date/Ely:y:e. ` l3 /// P
IN • 13125 SW Hall Blvd.,Tigard,OR 97223 plan Re{ieW
• Phone: 503.7182439 Fax: 503.598.1960 Date/By: " 1 ,3fp7
I
Inspection Line: 503.634.4175 Ready Date/By: Suns See Page 2 for
II'':I:n
- Internet: www.ligard-or.gov NotifiedrMetltod: I Supplemental Information
%TYPE OF WORK PLAN REVIEW
❑New construction Addition/alteration/replacement Please check an that apply(submit 1 sets of plans v/items checked):
0 Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other.
where the mvilabk 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 Multi-family ❑Master builderless m ground,orexceeds14.000 ❑Commercial-use agricultural
amps for all other nsmuaaoas. buildings.
0 Other: ❑Fire pump. 0 Installation of 150 KVA or
SOB SiTE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address: II ( Q '1u QS� 0 Addition of new motor load of system.
/� IOOHP or more. ❑"A""F""1-2""1-3,•
City/State/ZIP:l" ❑Six or more residential units. '.
( � l J r�-- ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldgJapt.#: Project name: 0 Hazardous locations. 0 Supply voltage for mom than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Desuipdoo I Qty. i Lath I Total I •
New residential single-or multi-family dwel g unit
Subdivision: Lot/: Includes attached garage.
1,000 sq.it or less. 16854 4
Tax map/parcel#: Ea add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
4t 11,G J t` ,�) _-.._�^. (with above sq.ft.)
�-,11`J I�'r 'l c Limited energy,multi-family 75.00 2
,Vfr �,� t T1 z,. residential(with above sq.ft.)
dPROPERTY OWNER I �eJ aNr RenewableEnetgy 0 See Page 2 ,
�'� T Services or feeders installation,alteration,and/or relocation
Name: c J l l J r 1pP e r Ly5 ��, 200 amps or less 1 100.70 2
Address: 1 201 amps to 400 amps 133.56 2
`�w Q5 401 amps to 600 amps 200.34 2
City/State/ZIP:'`'1 Q1 .N f 0 Yl__ 1-7 22—'3 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 55226 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 I 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
Branch circuits-new,alteration,or extension,per panel
AP LICANT ❑ CONTACT PERSON A.Feefor branch circuits with 1l
Business name: e(Olk.)t1 L each circuit
m � 13 7.42 2
Contact name: 1\34 Z-*Q B.Fee for branch circuits without
1•�' service or feeder fee,first
Address: e. T, t�C t branch circuit 56.18 2
City/State/ZIP: QH Each add'I branch circuit 7.42 2
� ) r`l Miscellaneous(service or feeder not included)
Phone ( ) I Z I I Fax::( ) Each manufactured ormodular
dwelling,service and/or feeder 67.84 2
Email: .( '5•. ✓s e C )1 l fJ ,��Cr'-, �Y✓i Reconnect only 67.84 2
1 r"�•/„GT CONTRACTOR T Pump or irrigation circle 67.84 2
Business name: 1.' `-.‘) (.. C1rsL , Signor outline lighting 67.84 2
Address: Signal circuits)or limited energy 0 See Page 2 2
- o cyx 3L.y-1 panel,alteration,or extension.
City/State/ZIP:G' E�S�oot M G k� CI"70 5 0 Each additional inspection
inspection(1hr min)
over allowable inany of the above
Additional (1 ht min) 66.25!hr
Phone:(C 3) ic(P 1__L.6 -• Z Fax:( .--)-----' investigation(1 ilr min) 90.00/hr
` J Industrial plant(l hr min) 78.18/hr
Email: �Ok E e l( .{•�, Cc,ya,•� i a Ic lL-y. Inspections for which no fee is '
CCB Lic.:�et0p-7S" Electrical Lic.:C.. `A _ Suprv.Lic.: SzAL specifically listed('/:brmin) �•�hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: i ,__",'^_ Subtotal:
Print name: �, ,_ _ Date: ( 1 _ 0 Plan Review Required(25%of permit fee):
'+°�+ �(l• Date: 1 R5 State surcharge(12%aof permit fee):
TOTAL PERMIT FEE:
AuthPrint d slgnatUfe This permit application expires if a permit is not obtained within 180
Print name: '7 `v. " �.--'y-1-1 ate: C7 11 Co '1 darn after it has been accepted as complete.
1 7l G i t t ' Number of inspections allowed per permit.
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