Permit CITY OF TIGARD ELECTRICAL PERMIT
a s . COMMUNITY DEVELOPMENT Permit#: ELC2020-00133
Date Issued: 03/09/2020
-FIG AR f7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S102CD01400
Jurisdiction: Tigard
Site address: 13565 SW ASH AVE
Project: GOULET Subdivision: FREWING'S ORCHARD TRACTS Lot: 16
Project Description: (3)branch circuits for kitchen remodel.
Contractor: METRO ELECTRIC Owner: GOULET, LAURA M & GERALD T
25027 SE HWY 224 13565 SW ASH AVE
BORING, OR 87009 TIGARD, OR 97223
PHONE: 503-320-2703 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 03/09/2020 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/09/2020 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 160 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. h e rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a co rules or direct questions to OUNC by calling 503.23 .19 44.
t
Issued By: Pe►mlttee Signature: .4''
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 r W FOR OFFICE. USE ON'I.l
City of Tigard Receivedriffir11114 q ' (AI, it ��
• 13125 SW Hall Blvd.,Tigard,OR 97223 L�20
�p Plan Review
iffrin
s Phone: 503.718.2439 1VIQ� N J i Date/B : Related Permit#:
Email: TigardBuildingPemtits@Tigardor.gov '�' " '' Mandy Dale/By: liiii ® See Page 2 for
("^R 1) Inspection Line: 503.639.4175 Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ddition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Budding over three stories.
❑Demolition El Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or ❑Floating buildings.
-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
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 A ['Emergency system. larger separately derived
Job#: Job site address: 3S�S � � '\_ ❑100 Addition of new motor load of system.
kg., 100HP or more. ❑
City/State/ZIP: ❑Six or more residential units. occupancy.
1�Q�+.'�-� Ovol 3 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: V l Project name: (06ci4 i — ❑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
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'I 500 sq.ft.or portion 33.92
rr ` \ �(� DESCRIPTIONy OF WORK Limited energy,residential 75.00 2
ge')c'7r fi12 1 tVf�O ��f`nCA.�, C`� ` 1-- (with above sq. t)
'T`+ tt Limited energy,multi-family 75.00 2
\ - residential(with above sq.ft.)
PROPERTY OWNER ❑ TENANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: C�/4 1�� C /G� l44 (-fit '` (Of 200 amps or less 100.70 2
Address: a GY 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
❑ APPLICANT El CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: /' above service or feeder fee,
/N(.s L1� � r �- S each branch circuit 7.42 2
Contact name: (� B.Fee for branch circuits without
Address: service or feeder fee,first branch circuit I 56.18 -tl6 13. 2
City/State/ZIP: Each add'l branch circuit p� 7.42 ) 1 34 2
Phone: Miscellaneous(service or feeder not included)
( ) 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: f, 0 6\A41/4.C.J Sign or outline lighting 67.84 2
S� ( l Signal circuit(s)or limited-energy
Address: �W 07 5 E 1'.w/ a-2.cl panel,alteration,or extension. ElSee Page 2 2
City/State/Z1P: P. Each additional Inspection over allowable in any of the above
ivCLs'+ (2\L (17y q7 Additional inspection(1 hr min) 66.25/hr
Phone:( ) SG 3--4 90-�`00 t Investigation(1 hr min) 90.00/hr
Email: E�,k6 10\e_`'C�� 90 TAIL,' V (ow- Inspection plant which hr min)no 78.I8/hr
J Inspections for no fee is 90.00/hr
CCB Lic.: ,2 \O Coc, Electrical Lic.: C) Suprv.Lic.: svk.k'j S specifically listed CA hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 1 ),(-y'a
Print name: p(K`S \_ � `1- Date: 9177 kirt.a0 0
Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): r,C/
TOTAL PERMIT FEE: 7
Authorized signature: Z
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
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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 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
❑ 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
CI Garage Door Opener* 50.01 to 100 kva 552.26 2
>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(4 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:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data 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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