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.
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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
❑ 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