Permit (48) p CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016-00073
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/01/2016
Parcel: 25111 BD01801
Jurisdiction: Tigard
Site address: 14850 100TH AVE
Project: Odell Subdivision: ALDERBROOK FARM Lot: 5
Project Description: (1)branch circuit to reconnect electrical stovetop.
Contractor: OWNER Owner: ODELL, ROBERT CHARLOTTE
ROBERT ODELL 14850 SW 100TH
14850 SW 100TH AVE TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 503-639-3221 PHONE: 503-639-3221
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 02/01/2016 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 02/01/2016 $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 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. ATTEon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0 0 throu/ghh OAR2- 1-0 90, ou may obtain a copy of the rules or direct questions to OUNC bycalling 5 1987 or 1.800.332.2344.
Issued y: L \. Permittee Signatur � G��1
OWNER INSTALLATION ONLY
The installation is being made on propert n 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
Re
City of Tigard Received / Permit#. Lz-eau& GYX,�7�j
IDa
te/B :
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#:
Inspection Line: 503.639.4175 Ready Date%By: iuris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK 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.
❑ 1-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
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
106#: 1017 site address:/(/- ? ❑Addition of new motor load of system.
57& Sj�c) �� 100 HP or more. ❑"A","E",-1-2",-1-3",
City/State/ZIP: /�� 12� ❑Six ormore residential units. occupancy.
l G�YsF d IR 9 7 ❑Recreational vehicle arks.
❑Health-care facilities. P
Suite/bldg./apt.#: ProjCct name: 'Rp b e e / ❑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 ITotal
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax trap/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
C 0/V/-CC vc---,f c Ar Limited energy,multi-family
75.00 `
residential(with above sq.ft.)
Renewable Energy See Page 2
PROPERTY OWNER
❑ TENANT Services or feeders installation,alteration,and/or relocation
Nance: 0 D Q 200 amps or less 100.70 2
Address: s 201 amps to 400 amps 133.56 2
401 at to 600 amps 200.34 2
City/State/ZIP: �' A Q �f 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: �ph2r� Cc�c�It1^06rvta.t do
relocation
Owner installation:This installation is being made on property that 1 own which is not 200 amps or less 59.36 1
intended for sale,lease,r t,or ex hange,a cording to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 2-� 16 401 amps to 599 amps 168.54 2
❑ APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension, er 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 56.18 15 / 2
branch circuit
City/State/ZIP: Each add']branch circuit 7.42 2
Miscellaneous service or feeder not included
Phone: ( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation 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
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: 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(/z hr min
ELECTRICAL-PERMIT FEES
Suprv. Electrician signature,required: Subtotal:
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of pen-nit fee):
Authorized signature: "Yl D TOTAL PERMIT FEE: a
This permit application expires if a permit is not obtained within 180
Print name: O(d O Date: �„ days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:BuildingPermits,ELC_Permit App ELR ERE.doc Rev 06172015 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
Description Qty. Each Total
Fee for all residential systems combined: $75.00 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 _5.52.26 2
F-1 Garage Door Opener* >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 I
charged at an hour) (1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('G hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I):
Fee for each commercial system: $75.00 * Number of inspections allowed per pennit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ 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
1:Building PermitsELC PermitApp_ELR_ERE.doc Rev 06'172015