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Permit CITY OF TIGARD ELECTRICAL PERMIT IN COMMUNITY DEVELOPMENT Permit#: ELC2015-00610 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/03/2015 Parcel: 2S104BC00600 Jurisdiction: Tigard Site address: 14115 SW FERN ST Project: Bahon Subdivision: HANDY ACRES Lot: 10 Project Description: (1)branch circuit for new a/c. Contractor: ELECTRO WIRE INC Owner: BOHAN FAMILY REVOCABLE TRUST 18857 SE SUNNYSIDE RD 14115 SW FERN ST BORING,OR 97009-9271 TIGARD, OR 97223 PHONE: 503-658-8136 PHONE: FAX: 503-658-7019 FEES Quantity Description Date Amount 1 crt Branch Circuits wo/Purchase 08/03/2015 $56.18 Specifics: Service or Feeder 1 ea 12%State Surcharge- 08/03/2015 $6.74 Type of Use: SF Electrical Class of Work: ALT 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 i accordance w - 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. • ENTION: Oregon aw re• es ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-0, -0010 through OAR 952-001 690. Yo m- 'btain a copy of the rules or direct questions to OUNC by callin. 503.232.1987 or 1.8 0.332.2344. Iss ed By: 0 �/ -' Permittee Signature: „a`,. ; '�!-.-�_ 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' �/ S .1 i . , i _� r Date: LICENSE NO. Q 7/ 7 S 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 USE ONLY City of Tigard 9K 722 E 3 C E I V E D Received r© ✓ pennit t. � //P l 0 '� s • 13125 SW Hall Blvd.,Tigard,OR Phone: 503.718.2439 Fax: 503.598.19 G 3 2015 Pt Plan Review Date/B : Related Permit 4: Inspection Line: 503.639.4175 Ready Date/By: Curb: ® See Page 2 for I I l;A R I) Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information TYPE OEta/U lNG DIVISION PLAN REVIEW ❑New construction Addition/alteration/replacement 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. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. R1.-1..,and 2-family dwelling El 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: El Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived Job#: t Job site address: ! !/ ($ /jam ❑Addition of new motor load of system. SL(.J �'- I OOHP or more. ❑"A" "E" "1-2" "1-3" /� ❑Six or more residential units. occupancy. City/State/ZIP: ��'�Ay �(Jam/ ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: I Project name: ❑Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qt . I Each l_ 'total I , New residential single-or multi-family dwelling unit. Subdivision: I Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea,add'I 500 sq.ft.or portion 33.92 I DESCRIPTION OF WORK Limited energy,residential 75.00 A 29-fr. /r (with above sq.ft.) 2 p�-(� ( 1 F r Limited energy,multi-family 75.00 residential(with above sq.ft.) ❑ PROPERTY OWNER I OWNER Renewable Energy ❑ See Page 2 ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 2 Address: 201 amps to 400 amps 133.56 2 - 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) I Fax:( ) Over 1,000 amps or volts _ 552.26 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 I 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: 4)I amps to 599 amps 168.54 ❑ APPLICANT I ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel J A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 each branch circuit Contact name: B.Fee for branch circuits without 16 service or feeder fee,first / 56.18 2 .18 SrP Address: branch circuit City/State/ZIP: Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) _ Phone:( ) I Fax: :( ) Each manufactured or modular 67.84 dwelling,service and/or feeder Email: _Reconnect only 67.84 2 �,,�� CONTRACTOR Pump or irrigation circle 67.84 2 Business name:Csi(-2C�/1-c) tO Z4.11.-. Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy ❑ See Page 2 Address: �' $ 7 S Q ITT panel,alteration,or extension. g City/State/ZIP: ` 7 tc (� Each additional inspection over allowable in any of the above 8,i_LAA4 Additional inspection(1 hr min) 66.25/hr Phone:gp� )��g Fax:�'D$) !p 5g �J3� Investigation(I hr min) 90.00/hr lEf/� ' ,^ Industrial plant(1 hr min) 78.18/hr Email: (QJ xQ� inspections for which no fee is 90.00/hr CCB Lic.:Gig77 I Electrical Lic.:2/c3-2/0 CI Suprv. Lic. 7)7S' specifically listed('/:hr min) - ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: 9p l Print name:4)Aut,.._ ret off`„ 5 40A, Date: _3/1_5 ❑Plan Review Required(25%of permit fee): / ��[ `� State surcharge(12%of permit fee): C." T Authorized signature: TOTAL PERMIT FEE: f This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as comqe. C ? Number of inspections allowed per permit. / „/ a z I.Building Permits•ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/CON/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 I • Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 1 00.70 2 5.01 to 15 kva 133.56 2 I 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 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >10O kva(fee in accordance with OAR 918-309-0040) 552.26 Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 n Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: n 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('!hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page I): (SEE OAR 918-309-0000) * Number of inspections allowed per permit. Check Type of Work Involved: n Audio and Stereo Systems I `- ❑ Boiler Controls 1 l'" CO El Clock Clock Systems Z g ❑ Data Telecommunication Instal • ❑ Fire Alarm Installation 1 ❑ HVAC El Instrumentation Intercom and Paging Systems Landscape Irrigation Control* Medical n Nurse Calls 1 P Outdoor Landscape Lighting* Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:Building,Permits■ELC_PennitApp_ELR_ERE.doc Rev 06/17/2015