Permit CITY OF TIGARD ELECTRICAL PERMIT
' ; COMMUNITY DEVELOPMENT Permit#: ELC2019-00861
Date Issued: 12/16/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S105DA16300
Jurisdiction: Tigard
Site address: 14595 SW KLIPSAN LN
Project: ZIMMERMAN Subdivision: PACIFIC CREST Lot: 51
Project Description: (1)branch circuit in garage.
Contractor: OWNER Owner: ZIMMERMAN, DAN T
DAN ZIMMERMAN 14595 SW KLIPSAN LN
14595 SW KLIPSAN LN TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-327-5670 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 12/16/2019 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/16/2019 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 Notifica.•n C> ter. Those rules are set forth in OAR
952-001-0010 through OAR . Y99 may obtain a copy or direct questions to OUNC by calling .232.1!:7 0 .800332.2344.
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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 ONLY
ewi <
City of Tigard ''y °
rw i Received
t :>_ • Date/B : /s P- 1 #:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review sill ��� i�
.. Phone: 503.718.2439 Fax: 503 598 1960,r. 1 7 0 a 19 Date/B : Related Permit#:
Inspection Line: 503.639.4175 - Ready Date/By: 111=111 El See Page 2 for
l IGARD Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction JC❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
El Demolition El Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
x❑ 1-and 2-family dwelling El Commercial/industrial El Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
El Multi-family El Master builder El Other: ❑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.
Job#: 001 Job site address: 14595 SW Klipsan Ln. ltOHP or more. ❑`A", `E, 1-z ,`1-3 ,
City/State/ZIP: Tigard, Oregon, 97223 0 Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
El Hazardous locations. 0 Supply voltage for more than
Suite/bldg./apt.#: Project name: NEMA 14-50 Install 0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: SW Sandridge Dr. FEE SCHEDULE
Description I Qty. I Each I Total I li
New residential single-or multi-family dwelling unit.
Subdivision: Pacific Crest Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:2S 105DA16300 Ea.add'I 500 sq.ft.or portion 33.92
DESCRIPTION OF WORK Limited energy,residential 75.00 2
Install new NEMA 14-50 receptacle in garage on new 50A breaker. (wit above sq.ft.) •
Limited energy,multi-family 75.00 2
6 AWG THHN wiring via V,,"ENT Raceway residential(with above sq.ft.)
Renewable Energy 0 See Page 2
❑X PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: Dan T.Zimmerman 200 amps or less 100.70 2
Address: 14595 SW Klipsan Ln. 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Tigard, OR, 97223 601 amps to 1,000 amps 301.04 2
Phone:(503 ) 327-5670 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: danz@pobox.com relocation
Owner installation:Thi : :Ilation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease, •nt,o ex.. ange,according to ORS 447,449,670, d 70 . 201 amps to 400 amps 125.08 2
Owner signature: j Date: / 401 amps to 599 amps 168.54 2
El APPLICAt r 0 CONTACT P RS 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
service or feeder fee,first 1 56.18 56.18 2
Address:
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:
( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: 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(I hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 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.Lie.: specifically listed(Y:hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal 56.18
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 6.74
Authorized signature: TOTAL PERMIT FEE: $62.9A
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.
1:1Building\Permits\ELC_PermitApp ELR ERE.doe Rev 06/17/2015 440.4615T(II/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
criFee for all residential systems combined: $75.00 RP ene
w°" Qty. Each Total I R
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva o less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to25 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
with OAR 918-309-0040) 552.26 2
❑ 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,E hr
specifically listed('A 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:
U Audio and Stereo Systems
Boiler Controls
❑ Clock Systems
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n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
E Instrumentation
Li Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
U Protective Signaling
n Other:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
I:1Building\Permits\ELC_PermitApp_ELR ERE.doc Rev 06/17/2015