Permit CITY OF TIGARD ELECTRICAL PERMIT
I COMMUNITY DEVELOPMENT Permit#: ELC2020-00123
T I GA R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/04/2020
Parcel: 15134ACO2660
Jurisdiction: Tigard
Site address: 11338 SW COTTONWOOD LN
Project: Lamont Subdivision: ENGLEWOOD NO.3 Lot: 226
Project Description: Adding(2)branch circuits for new bathtub.
Contractor: BRIGHTSIDE ELECTRIC& LIGHTING SERV Owner: LAMONT, CHERYL A
PO BOX 930 11338 SW COTTONWOOD LN
CARLTON, OR 97111 TIGARD, OR 97223
PHONE: 503-852-7900 PHONE:
FAX: 503-852-9573
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 03/04/2020 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/04/2020 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 follow the ules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through O 952 01-009 ou m tain a co of the ru or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. _v
Issued By: Permittee Signature: C�"/j Q✓�jL � �
OWNER INSTALLATION ONLY �V
The installation is being made on properly 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 603.639.4175 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.
.• . _. . __ , .
Electric* Permit Application 10)1... 1)14-1( I I ,.„I (,,..1 , ..
, City of Tigard Received
IN13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review --
11 ' Phone: 503.7182439 Fax: 503.598.1960 DaterBy:- Other Permit:
p Inspection Line: 503.639.4175 ' Date Ready/By: kris. a See Page 2 for
Internet: www.tigard-or.gov , 1 Notified/Method , Supplemental Information
. . , , - - - - • •
TYPE O WORK . PLAN REVIEW
0 New construction .Addition/alteration/replacement Please check all that apply(subnitt 2 sets of plans w/items checked below):
E3 Service or feeder 400 amps or more El Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
cA.Trootty or comptocriori - • , exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less as ground,or exceeds 14,000 0 Commercial-use agricultural
21 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
E3 Multi-family 0 Master builder P Other: 0 File pump 0 Installation of 75 KVA or
• . -- -- • . ., 0 Emergency system. larger separately derived system.
r-Irk.SF-17E.',PTOR?&W.104:4:1;"1:0-.14.0PATIO;t74 -,:, -,-.. - .---. ..: :.', 0 Addition of new motor load of 0"A",ur,-1-2","1-3",
0
Job no.:zo4e-ye, Job site address-. i/5,5e J,,, 64 list(IMOD /40 I00HP or more. occupancy.
Six or more residential units. 0 Recreational vehicle parks.
CI Health-care facilities. 0 Supply voltage for more than
City/State/ZIP: -1"-- .,..,,,,. A II 9 7z,z.
Suiteibldg japt no.: t/fm.'-vri''. 0 Hazanious locations. 600 volts nominal.
Project name: tekc 4. 0 Service or feeder 600 maps or more.
FEE SCDIILE
Cross street/directions to job site: ,9 W Wi Wow te.(Jcbo c.r D...yoso. . Qty. I F . I Fetal I *
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'1500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 75.00 2
' - '. '-- ''-2 ' ' ''' '• • --ttrataurnotit-ca6kroicia-, - : 7 '- ' '- (with above eq.ft.)
Limited energy,multi-family 75.00 2.
Ale7 1-42.01/Ad fi- 6c-ei C.,/it:c4/4 FekNex•0 zehd 7-ti residential(with above sq.ft.)
Seridees or feeders installation,alteration,suidfor relocation
.eZ 10 (414CA. /.."Ifecf In 200 amps or less 100.70 2
I-PParrtoioulat. . -I-- , .-. . .. -la-trtmair ... ... --- . 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
City/State/ZIP: relocation
200 amps 01 less 59.36, 1
Phone:( ) Fax:( )
Owner installadon:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
401 amps to 599 amps 168.54 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701.
Branch circuits-new,alteration,or extension,per panel
Owner signature: Date:
A.Fee for branch circuits with
above service or feeder fee, 7.42 2
_
Business name: B.Fee for branch circuits without
Service or feeder fee,Ent
Contact name: branch circuit / 56.18 5-‘,./b1 2
Each add'l branch circuit / 7.42 7,.yg_. 2
Address: Miscellaneous(service or feeder not included)
Each manufactured or modular
City/State/ZIP: dwelling,service and/or feeder 67.84 2
Phone:( ) Fax :( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: • Sign or outline lighting 67.84 2
" . . . - -. - •.. -, • .,..
Business name: //AVve. .6":"7/454/e; panel,alteration,or extension. Page 2
Bach additional inspection over allowable in any of the above' 2
Address: Po 9 3D Additional Inspection(1 hr min) 6625/hr
Investigation(I tar min) 66.25/br
City/State/ZIP: CA1°,1 .01 el/1— 'r7/// Industrial plant(1 hr min) 78.18/by .
Phone:(fa?) fro-2._ 79 erit Fax:cre 3 ) 51-2—95"7 5 Inspections for which no fee is 90.00/hr
specifically listed_ch lir min)
CCB Lie.: /977'6-e Electrical Lic...4"--/ya c_ Suprv.Lic.:1:75Pe 5
Subtotal: ‘ 3, 6 elSuprv.
Suprv.Electrician signature,required: Plan review(25%of permit foe): .
/
Print name: °Alp rl 4 -,‘,4/ 4,pa State surcharge(12%of permit fee): 7
TOTAL PERMIT FEE: 7/ , 2 3
Authorized signature: /V / This permit application expires if a permit is not obtained within lin
days after it has been accepted as complete.
Print name: L./ix/ '),,,, /11; 144:4 Date.., .46 • Number of inspections allowed per permit
lattulelegtPeremicaNELC-PeemitAlop.dec 07/01/10 440-4615T(11/05/COWWEB