Permit CITY OF TIGARD ELECTRICAL PERMIT
1111 ' COMMUNITY DEVELOPMENT Permit#: ELC2015-00484
1 D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/22/2015
Parcel: 1 S 136CA02201
Jurisdiction: Tigard
Site address: 10940 SW 79TH AVE
Project: SOLUTIONSTAR Subdivision: MARG TERRACE Lot: 1
Project Description: Reconnect only.
Contractor: Owner: SOLUTIONSTAR
8950 CYPRESS WATERS BLVD
COPPELL,TX 75019
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 06/22/2015 $67.84
Specifics: 1 ea 12%State Surcharge- 06/22/2015 $8.14
Electrical
Type of Use: SF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
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 obtai les or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
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 r 'e c t\J FOR OFFICE('SE ONLY
City of Tigard 1
13125 SW Hall Blvd.,Tigard,OR 97223 �� _ _ I r .;♦ill
= g' Plan Review
I Phone 503.718.2439 Fax: 503 598.1960 18 2015 Date/By: Related Permit k:
Inspection Line: 503.639.4175 )UN Ready Date/By lulls 0 See Page 2 for
f IGAK Q Intenxl www tigard orgov oifeeo Supplemental Information
V TYPE OF WO fit' 11
Vitt '. [ � ,1�-ic+lf 1-} ' r„ . ,'`` PI AN"`REVJEIV' t -
•❑New construction ®Addition/altera ��0p gpt� Please check all that apply(submit 2 sets of plans w/items checked)
❑Service or feeder 400 amps or more ❑Building
over three stories.❑Demolition ❑Other:
where the available fault current ❑Marinas and boatyards.
yq i ' - EGORY:"OF'COINSTRUCT]IO 4 , '!#r exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
?S -!lx.' ' 'r; JOB SITE'JNFORMATION;AND LOCATION ❑Emergency system. larger separately derived
Job it: Job site address: 10940 SW 79th A V E ❑Addition of new motor load of system.
IOOHP or more.
City/State/ZIP:Tigard,OR.97223 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:
^' /���/Z 0 Hazardous locations. Supply voltage for more than
���'V '--'/ 1 ❑Service or feeder 600 amps or more 600 volts nominal.
Cross street/directions to job site: ' FEE°SCHEDULE, G 4', Il c
Description I Qty. I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: Lot 4: Includes attached garage.
Tax map/parcel 4: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq it or portion 33.92 I
= 'DESCRIPTION OF'WORK'' Limited energy,residential 75.00 2
(with above sq.ft.)
Re-connect only Limited energy,multi-family 75.00 2
residential(with above sq.ft)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I ❑_TENANT Services or feeders installation,alteration,and/or relocation
Name: 774(t^ 'na t { 200 amps or less 100.70 2
301 amps to 400 amps 133.56 Address: 66160 C_A f er,e S S / w'}r'+ ehibi
401 amps to 600 amps 200.34
City/State/ZIP: (.4oppeAl I TX "7� (q 601 amps to 1,0(10 amps 301.04 2
��// Over 1,000 amps or volts 552.26 2
Phone:( ) Fax:( )
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
'-❑APPLICANT'', I , ® CONTACT'PERSON -• Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits a itb
Business name:All Around Maintenance Inc. above service or feeder fee,
each branch circuit 7 4— 2
Contact name:Alena Gorbunova B.Fee for branch circuits without
Address:3502. '2890'Si service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Ridgefield,WA.98642 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)887-2129 Fax: :( ) Each manufactured or modular
dwelling,service and or feeder 67 84 2
Email: allaround.maintenance'yahoo.com Reconnect only X 67 S4 I 2
CONTRACTOR Pump or imgation circle 67 84 2
Business name: Sign or outline lighting 67 84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. ❑ See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP: Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(I hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: .
Inspections for which no fee is 90.00!hr
CCB Lic.: Electrical Lie.: Suprv.Lie.: , speciiical'listed('/:hr min)
t '•ELECTRICAL'.PERMIT'F,EES:
Suprv.Electrician signature,required: Subtotal:
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: 4 [mod-e/.2 LB(�Gi TOTAL PERMIT FEE $75 98
!/ This permit application expires if a permit is not obtained within 1811
Print name: Alena Gorbunova Date: 6/18/15 days after it has been accepted as complete.
• Number of inspections allowed per permit.
1 Budne di t'crmns It C_Pernnt.4pp PLR_IRE doe Res 0o.'17,2015 490-4615'1(1 1l05 COhL'R7iB
■
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 RefewQty.a" I Qty. I Each l rotoJ
3' 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
H 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:
n O• ther Each additional inspection is 66.25.hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90 00.hr
:hecificnll.hilted f':hr mini
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I)
Fee for each commercial system: S75.00 . Number of inspections allowed per permit
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
l3oiler Controls
❑ C• lock Systems
❑ Data Telecommunication Installation
7 F• ire Alarm Installation
HVAC
n instrumentation
1 Intercom and Paging Systems
n Landscape Irrigation Control*
❑ M• edical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
Iiwldmg\Permits\ELC_PurmiApp_ELR_ERE.doe Rev 06/17/2015