Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2015-00657
Date Issued: 08/18/2015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S134CA03700
Jurisdiction: Tigard
Site address: 11770 SW NORTH DAKOTA ST
Project: Forrester Subdivision: BURLWOOD NO.2 Lot: 10
Project Description: Adding(2)branch circuits for new bedrooms.
Contractor: BANDANA ELECTRIC LLC Owner: FORRESTER, BRIONA L&TIMOTHY J
PO BOX 623 11770 SW NORTH DAKOTA ST
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 971-221-6948 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 08/18/2015 $63.60
Specifics:, Service or Feeder
1 ea 12%State Surcharge- 08/18/2015 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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. ATT -!•n law re•uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-00 010 through OAR • 2-0r $09 Y•u may obtain a copy of the rules or direct questions to OUNC by callin. 503. 32.1987 or 1.800.332.2344.
Is ed By: ` Permittee Signato-: 1_ _r �..�..i/ /�
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
T
SIGNATURE OF SUPR.ELEC' — — u, dip , ��, Date: OAS"
LICENSE NO. 5b 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 1OH Ot1l( I I `1: (1\1 'i
City of Tigard R E C Cl/E1- Received �✓ �
•*Received
t �oyl Permit 6: , //S„ls /
• 13125 SW Hall Blvd.,Tigard,OR 97223 ' Plan Review
s Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
A U
Inspection Line: 503.639.4175 G 1 8 2 015 Ready Date/By: funs: lifi See Page 2 for
A I Il Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY O; .TIGARD
TYPE OF W( 11 -1. PLAN REVIEW fr,❑New construction ddition/alteration/repfiacement` _,,u I J Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
D
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
`.'-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
Multi-family Master builder Other:
amps umpll other installations. Installation❑ y ❑ ❑ 0 pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address:1 r� ,1 f� ,/ t� ❑Addition of new motor load of system.
:111 rC) 51A) Ne QC.I' t, 5 , 100HP or more. ❑ A, E„ "l-2” l-3
City/State/ZIP: '• 1 1 oR 912'a�2 ❑Six or more residential units. °ceW�y.
11 Recreational vehicle parks.
y^ ❑Haza douse locations. ❑ o
Suite/bldg./apt.#: Project name: �yv_t��y.„ IT,,,��1 ❑Hazardous locations. ❑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 Qty. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
A a\ 1 C` �{y�, for ` o rNS (with above sm multi
-family
A- 1 J D Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
❑ PROPY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: .iQ e/ /Z. 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:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
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 t
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
it APPLICANT 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
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first I 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 1 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: kRitia_ cA fir1 c LAC Sign or outline lighting 67.84 2
Address: P:7 e cn Signal ltera t(s)or limited-energy ❑ �Page 2 2
C, f, panel,alteration,or extension.
City/State/ZIP: . 9110 13 Each additional inspection over allowable in any of the above
1
Additional inspection(1 hr min) 66.25/hr
Phone:(Cr)i ) Zti..b 4 Q Fax:( ) Investigation(1 hr min) 90.00/hr
Email: .1 VV J Industrial plant(1 hr min) 78.18/hr
0.� t'►r��C.� �f.t t^r�l/t//� /o%be Inspections for which no fee is
90.00/hr
CCB Lic.: ,9 cgi0a J, 4 Electrica ic.:ccpi 1 Suprv.Lic.:5860S specifically listed CA hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ,(9,�- Subtotal: 63,u)
Print name: k:1041' 0(; c n Date: $-rr)_15 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): ,Coll
Authorized signature:
TOTAL PERMIT FEE: 9 1,
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete. • a3
• Number of inspections allowed per permit. it
1.Building\Permits\ELC_PermitApp_Et.R_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
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 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or Tess 100.70 2
5.01 to 15 kva 133.56 2
El 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
El 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
El 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
specifically listed(Y2 hr min) 00/hr
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
y ' Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
El C• lock Systems
❑ D• ata Telecommunication Installation
❑ F• ire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
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