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Permit CITY OF TIGARD ELECTRICAL PERMIT 11. ' COMMUNITY DEVELOPMENT Permit#: ELC2020-00143 Date Issued: 03/11/2020 Tr G A.Ji,I_'' 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103BD02300 Jurisdiction: Tigard Site address: 11760 SW CARMEN ST Project: SMITH Subdivision: CARMEN PARK Lot: 8 Project Description: (1)subpanel and(2)branch circuits for lighting and receptacles in garage. Contractor: OWNER Owner: SMITH, ROSS JAY ROSS SMITH 11760 SW CARMEN ST 11760 SW CARMEN ST TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503-521-0727 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders-200 03/11/2020 $100.70 Specifics: amps or less 2 crt Branch Circuits w/Purchase 03/11/2020 $14.84 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 03/11/2020 $13.86 Electrical Type of Const: Occupancy Grp: Total $129.40 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 Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain py-ef t les or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: ttee Signature: /�`y -j � �� 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 LSE ONLY City of Tigard ^r'i I C . Received OE • 13125 SW Hall Blvd.,Tigard,OR 97223R {M� V G Da : ��� _ _ �� t� Review II g Plann/:Phone: 503.718.2439 fq Date : W57sf1x>l��A I I G A H n Email: TigardBuildingPermits@Tigard-or.go 1 1 Z020 Ready Date/By: ® See Page 2 for Inspection Line: 503.639.4175 Internet: wtihki:figard-or.gov n Notified/Method: . Supplemental Information TYPE OF WORK CI I N O "I" I `,nn11nnIIa QON PLAN REVIEW ❑New construction ❑ Addition/alteratiorzwup Please check all that apply(submit 2 sets of plans w/items checked): ❑ Demolition ❑ Other: 0 Service or feeder 400 amps or more 0 Building over three stories. where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling ElCommercial/industrial El 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. ['Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: // 766 S.1a/. L AW/y E.k., S 7. 1001W or more. ❑"A","E",`°1-z","I-3", City/State/ZIP: : ❑Six or more residential units. occupancy. —T�ri/l(L f? c3 It- 97Z2"? 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: I Project name: 0 Hazardous locations. ID Supply voltage for more than SM/Yf/ ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: f J 5 rr/ w ,�/r.T FEE SCHEDULE Description I Qty. I Each I Total I New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add']500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential [ (with above sq.ft.) 75.00 2 CI 'S£.cr P a C() Ce ,4", �r r+t' /i,4 t,q 4---1 Limited energy,multi-family ,J residential(with above sq.ft.) 75.00 2 Renewable Energy ElSee Page 2 0TENANT ❑ PROPERTY OWNERServices or feeders installation,alteration,and/or relocation Name: k Vu ✓.. `S/ry/ Tfi 200 amps or less / 100.70 jid.70 2 Address: // S-h./. G ��A'M S7' 201 amps to 400 amps 00.34 2 401 amps to 600 amps 200.34 2 City/State/ZIP: -77 G.A c b Oh_ 972r2-? 601 amps to 1,000 amps 301.04 2 Phone:(�z.3) 6-Z/- G 72 7 Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I intended for sale,lease,rent,or exchange,according to O S 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: — I c-c,j Date:_?/j/., 401 amps to 599 amps 168.54 2 0 APPLICANT I 0 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 /// 'q 2 Contact name: B.Fee for branch circuits without _\ __!f�• D Address: service or feeder fee,first 56.18 2 branch circuit City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) 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 Signal circuit(s)or limited-energy Address: ❑ See Page 2 2 panel,alteration,or extension. CitylState/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(I hr min) 78.18/hr Inspections for which no fee is CCB Lic.: Electrical Lie.: Suprv.Lie.: specifically listed(''/hr min) 90.00/hr ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal• "r 5—if Print name: Date: 0 Plan Review Required(25%ofpermit fee): State surcharge(12%of permit fee): / 3, yip Authorized signature: TOTAL PERMIT FEE: `yt/, Yi) 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. I:\Building\Permits\ELC_PermitApp ELR ERE.doc Rev 10/26/2017 440-46I5T(11/05/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 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 ❑ 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 n 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: ❑ 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: 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 I1.BsildwgTermits\ELC_PermiIApp_ELR_ERE.doc Rev 10/26/2017