Permit (2) CITY OF TIGARD ELECTRICAL PERMIT
. ' COMMUNITY DEVELOPMENT Permit#: ELC2020-00023
T I GA!.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/15/2020
Parcel: 1 S135DD03617
Jurisdiction: Tigard
Site address: 11410 SW LOMITA AVE
Project: Repta Subdivision: LOMITA TERRACE Lot: 16
Project Description: Reconnect only.
Contractor: Owner: FEDERAL NATIONAL MORTGAGE ASSN
BY CHAMPION MORTGAGE CO
8950 CYPRESS WATERS BLVD
COPPELL, TX 75019
PHONE: 503-332-1229
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 01/15/2020 $67.84
Specifics:
1 ea 12%State Surcharge- 01/15/2020 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports(Conditions)
This permit is issued subject to the regulations tained 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. Thi ermit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon w requires yo folio e s adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OA 001-0090 tar o the rules or direct questions to OUNC by calling 50 1 8 3
Issued By: 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 FOR OFFICE USE On1.I
City of Tigard Received
Date/B : . � /11 .Its .����� /��.
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
I Phone: 503.718.2439 Date/B : Related Permit#:
Email: TigardBuildingPerinits@Tigard-or.gov Ready Date/By: Jura: ® See Page 2 for
T I G A R D Inspection Line: 503.639.4175 Internet: www.tigard-orgov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ition/alteration/replacement Please check all that apply(submit J sets of plans w/items checked):
❑Service or feeder 400 amps or more CIBuilding over three stories.
El 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.
2-family dwelling ElCommercial/industrial El Accessory building less to ground,or exceeds I4,000 El Commercial-use agricultural
amps for all other installations. buildings.
Multi-family ❑Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: 111110
`` ' Ave ❑Addition of new motor load of system.
'1��� LOwt�q A • IOOHP or more. ❑system.
City/State/ZIP: `���p a (''� (� y •� ❑Six or more residential units. occupancy.
tY =V`�" (Az J _` `2+Z' •� ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I-100 Project name: ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross strtxt/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: 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 I
DESCRIPTION OF WORK Limited energy,residential
t- It G1Y__l v a G] itlSa� C '(f!1'11'1'@C.k.J\ (with above sq.ft.) 75.00 2
l C�\ vmh TJ Limited energy,multi-family 75.00 2
( residential(with above sq.ft.)
Renewable Energy 0 See Page 2
PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: r(J.41 Re r i 200 amps or less 100.70 2
Address: tI,4op sW atoll •/ tt. 201 amps to 400 amps 133.56 2
J 401 amps to 600 amps 200.34 2
City/State/Z1P: j 4 OR ` �t7 ZZ3 601 amps to 1,000 amps 301.04 2
Phone:(6c3) 33 r ' 5t Over 1,000 amps or volts 552.26 2
L r Temporary services or feeders installation,alteration,and/or
Email: Ytpies I qNWIAL C.O M relocation
Owner installation:This i, . ...1 islet't_• n• •_. t roperty that I own which is not 200 amps or less 59.36 1
intended for sale,I-:: ,rent,or . :e, .• t • . i RS 7,449,670' •
,7151
d7 II.`�' 201 amps to 400 amps 125.08 2
Owner signature: Date: ! a•'_r•L) 401 amps to 599 amps 168.54 2
❑ APPLICANT I CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit _
City/State/ZIP: Each add'l branch circuit 7.42 2
Phone: Miscellaneous(service or feeder not included)
( ) Each manufactured or modular
Email: dwelling,service and/or feeder 67.84 2
Reconnect only / 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Investigation(I hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(/z hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signatur : TOTAL PERMIT FEE:4.....,(.2
// Thisit application expires if a permit ti not obtained within 180
Print name: Date: �/(�/war) perm days after it has been accepted as complete.
((( * Number of inspections allowed per permit
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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
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
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:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ 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:
❑ 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: Et ECTRICAI PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
y ' 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
n D• ata Telecommunication Installation •
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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