Permit CITY OF TIGARD ELECTRICAL PERMIT
al
COMMUNITY DEVELOPMENT Permit#: ELC2014-00167
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/14/2014
Parcel: 1 S 136CA02900
Jurisdiction: Tigard
Site address: 11155 SW 79TH AVE
Project: Green Subdivision: FRIENDLY ACRES Lot: 20
Project Description: Change and relocate panel and(12)branch circuits.
Contractor: OWNER Owner: GREEN, KEVIN&NATASHA
KEVIN GREEN 11155 SW 79TH AVE
11155 SW 79TH AVE TIGARD,OR 97223
TIGARD, OR 97223
PHONE: 971-832-4969 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 04/14/2014 $100.70
Specifics: amps or less
12 crt Branch Circuits w/Purchase 04/14/2014 $89.04
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 04/14/2014 $22.77
Electrical
Type of Const:
Occupancy Grp:
Total $212.51
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 o er applicable law. All work will
be done in a with approved plans. This permit will expire if work is not started within 180 days of issuance, or if wo is suspended for more the 180
days. A NTION: Oreg law equires you to follow the rules adopted by the Oregon Utility Notification Ce• h. e rules are set forth in OAR
952-0 -0010 through OAR 95 - 1-0 . You may obtain a py of the rules or direct questions to OUNC by callin 503.23 . •r r r. 32.2344.
By:Iss ed
y: Permittee Signature: � A`t.'
OWNER INSTALLATION ONLY
The installation is being made on props I•• wh'4 i L of intended for sale,lease or rent.
OWNER'S SIGNATURE L I---/ Date:
///v
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 Applicatio 1.0R 01.-1,1(-F I SI.O\1.1
City of Tigard w ed PermitNo.: e 4)/ —�/( 7
114 13125 SW Hall Blvd.,Tigard,OR EiGE1VED Plan Review
Phone: 503.718.2439 Fax: 503.598.19 Da1e/By: Other Permit.
III„Aiil)
Inspection Line: 503.639.4175 �P R 14 2014 Date Ready/By: ruris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
c�no�rn
TYPE OF ..t'1 ;Illr t11�141�1�►1 PLAN REVIEW
❑New construction pj Addition/alteratlo replacement Please check all that apply(submit a sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
lEj 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: Job site address: IOOHP or more. occupancy.
1 135 JLN 9 0 Six or more residential units. ❑Recreational vehicle parks.
`� ,p /� ❑Health-care facilities. ❑Supply voltage for more than
City/State/ZIP:
1 i9 J/) J '7 2 23 ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: l t�.Project name: ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total 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'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Pt /� /� I n �j, Limited energy,multi-family 75.00 2
l �1446e— 4 veiA6('hn.%. ual C 1✓GU 1T5 residential(with above sq.ft.)
U Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
PO PROPERTY OWNER I ❑ TENANT 200 amps or less ( 100.70 /eV.i) 2
201 amps to 400 amps 133.56 2
Name: ,
P l� CRS P(.L. 401 amps to 600 amps 200.34 2
Address: l 1)55 St,.l 79 Act_ 601 amps to 1,000 amps 301.04 2
T Over 1,000 amps or volts 552.26 2
City/State/ZIP: l�, Dk 17)a'l
Temporary services or feeders installation,alteration,and/or
Phone:( �) _ I ei6e Fax:( ) relocation
L 200 amps or less 59.36 1
Owner installation:This instal ation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,le:- , - , t xchange,according to ORS 447,449,670,and 7011./ 401 amps to 599 amps 168.54 2
Owner signature: ' Date: ;IV f V--1(L( Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
PLICANT I El CONTACT PERSON above service or feeder fee, /9-, 7 42 V,c 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name:f ) ' service or feeder fee,first
� branch circuit 56.18 2
Address: !115(.. .9k, / 'b Y Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP:
Aga. O.. e7a�3 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Phone:(�(lt) �9 T Fax: :( ) Reconnect only 67.84 2
C�
E-mail: `, 1/300 M ZL•.f)iii,„ Pump or irrigation circle 67.84 2
., ? ;'; CONTRACTOR Sign or outline lighting 67.84 2
Business name: Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:
Investigation(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(Vs hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: /g9,74
Print name: Date:
Plan review(25%of permit fee):
State surcharge(12%of permit fee): ,9,A,-77
Authorized signature: TOTAL PERMIT FEE: A. 5/
Print name: Date: This permit application expires if a permit is not obtained within 180
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
Fee for all residential systems combined $75.00 Description I Qtr. I Fee I total
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
1-1
Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with
❑ Heating, Ventilation and Air Conditioning OAR918-309-0040) 552.26 2
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
ElOther: additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr
Inspections for which no fee is 90.00/hr
specifically listed(%l hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
Number of inspections allowed per permit
❑ 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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