Permit CITY OF TIGARD ELECTRICAL PERMIT
`�7 I_` ' COMMUNITY DEVELOPMENT Permit#: ELC2020-00239
Date Issued: 05/28/2020
T[GA L1 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 1 S133DA07600
Jurisdiction: Tigard
Site address: 12612 SW SNOW BRUSH CT
Project: Kruger Subdivision: AMART SUMMER LAKE NO.2 Lot: 136
Project Description: (1)branch circuit for new ceiling fan.
Contractor: OWNER Owner: KRUGER, DENNIS A TR&
KRUGER,WENDY L TR
12612 SW SNOW BRUSH CT
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 05/19/2020 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 05/19/2020 $6.74
Type of Use: SF Electrical
Class of Work: OTR
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 Notification Center. Those rules are set forth in OAR
952-001-0010 through 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ��� />'L(:'(a� Permittee Signature: QAJ A;27.n/'C_ / e7 y7U/t,
OWNER INSTALLATION ONLY
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 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.
EL
Electrical Permit Applicatio jET �„
City of Tigard Doren : ,sly �2 i 'i
III • 13125 SW Hall Blvd.,Tigard,OR 97223 APR 3 0 2020 DstdBy. /Zr1 � °�`"E a 3
Plan Review
I Phone: 503.718.2439 Fax: 503.598.t9 r DatdBy: Related Permit u:
'C I(i.A It i) Inspection Line: 503.639.4175 ( I Y O F- 1(lMR E) Ready Date/By: �. Arr. H See Page 2 for
Internet: www.tigard-or.gov 3uILDING D IVISI i)P�SNotifio 9Method: /�/ ) -we' Supplemental Information
TYPE OF WORK &--1l'17(,_. 4-J1,0f'PLAN REVIEW
❑New construction Addition/alteration/replacement Please cheek all that apply(submit,,sets of plans wlitems checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or ❑Floating buildings.
xrl-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-ise agricultural
amps for all other installations, buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system, larger separately derived
of
Job#: Job site address:j,Z IL S vj aj E,i4, } Cr ❑AdditionOOHP HP ormornre.motor load of system
. ❑"A" "E""i-2".•1-3"
City/State/ZIP: 'T� `� /` a� �y y '°� Psi:,or more residential units. occupancy.
• \ t GE�4 / f p, / "I I -•+ ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bld ./ t.#: .-. Project name: ice) l^ '' ❑Hazardous locations. ❑Supply voltage for more than
g J t L,tIV� i f V,•a600 volts nominal.
0 Service or feeder 600 snips or morc.
Cross street/directions to job Site: FEE SCHEDULE
nacdetion I Qtr. I Fads I Total I "
AeT New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: ,�� �map_ LAKE a Lot#: (3� Sa g
1,000 sq.fl.or less 168.54 4
Tax map/parcel#: f C j A 0 A o-7 In d 0 Ea.add'l 500 sq.R.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
m,-Pia l PCsC SI
41UST4 Cx WAIL 54.4 TC foLLTL T`Tf) Limited ere gy multi-family
75.00 2
* s n.�r do az bo a rs- residential(with above sq.ft.)
�GZi) GGttJA�Ci �al� lidl (�i7�L t tu�Laa:,F,,,x.t` Renewable Energy ❑ See Page 2
PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: llE J W S 'RU. 4 200 amps or less 100.70 2
: 7 + 01 amps to 400 amps 133.56 2
Address 2
{ .6, (yb. S Yti r�4.5iv.i S.I'AI S r[ CrC r 401 amps to 600 amps 200.34 2
City/State/ZIP:'TT G A(Lc)jU / (�;r7 L2- 601 amps to 1,000 amps 301.04 2+
Phone:(SO) 1;)--/1;)--/9 4 iT f (1,4 Fax:( ) -------- Over 1,000 amps or volts 552.26 2
.�, Temporary services or feeders installation,alteration,and/or
Email:f ? t1 A a t1 b k rtiel. e r&W r dart-Lien a rn relocation
Owner installation:This installation isbeing made on property that I own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchan[ ace rr9mg to ORS 447,449,670 a/gel 70l 201 amps to 400 amps 125.08 2
s I�r. Date: 2/7d Z[i not amps to 599 amps I68.54 2
Owner signature: �
&PPLICANT I CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: ••— -•-.�„� above service or feeder fee, 7.42 2
-EN
_ yE_ each branch circuit
Contact name: ti c iN d�i fl uf W e- al ,e A pt,t.vE B.Fee for branch circuits without '
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:( ) Fax::( ) Each manufactured or modular 67.84 2
F 'I' dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: — 100'Ve:*Ow 0 e a t .dZ� i? Sign or outline lighting 67.84 2
`�1'�•-- Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. 0 See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP: Additional inspection(1 In min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCBLie.: Electrical Lie.: Suprv.Lic.: specifically listed(1hrmin)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: .£4 .I e
Print name: Date: 0 Plan Review Required(25%of permit fee): �r�
State surcharge(12%of permit fee): (6 41T
Authorized signature: TOTAL PERMIT FEE: �'Z 4ef Z„
Print name: net 1 A K.i.t - Date: 4/ /2 A prey daysapplicati r it has been a accperepted
as complot eieed within ISO
v Says after it has been as complete.
• Number of inspections allowed per permit.
I.\Bmldiag\Perms1ELC PensntApp_ELR_ltREdoe Rev 04f17/2015 440-16157111tti5/COM/WEB /
v
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
•
Fee for all residential systems combined: $75.00 fpliai I Q� Each I row I
)' Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less I00.70 2
5.01 to 15 kva 133.56 2
H 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
I I Garage Door Opener* 50.01 to 100 kva 552.26 2
u +� p >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
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('i hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal
Fee for each commercial system: $75.00permit.
y ' Number of inspections allowedper penmit.l. Pagenter on I)
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
E Boiler Controls Vit
❑ Clock Systems
E Data Telecommunication Installation IV 0 rUL
E Fire Alarm Installation A/A
❑ HVAC jj: 1:
ISO
❑ Instrumentation
n Intercom and Paging Systems
E Landscape Irrigation Control*
❑ Medical
n N• urse Calls
(l O• utdoor 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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