Permit (46) CITY OF TIGARD ELECTRICAL PERMIT
- 2e. ', COMMUNITY DEVELOPMENT
Permit#: ELC2017-00041
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/18/2017
T f aA Parcel: 2S 102BA01502
Jurisdiction: Tigard
Site address: 12330 SW GRANT AVE
Project: Islas Subdivision:RTH TIGARDVILLE ADDITION,AMENC Lot: 13
Project Description: Electrical reconnect
Contractor: N/A Owner: SALTO, RAMIRO ISLAS
12330 SW GRANT AVE
TIGARD, OR 97224
PHONE:
PHONE: 503-608-9269
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 01/18/2017 $67.84
Specifics:
1 ea 12%State Surcharge- 01/18/2017 $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 - d all o er ••cable law. All work will
be done in •r•a ith approved plans. This permit will expire if work is not started within 180 days of issuanc-, o if w suspended for more the 180
days. AT ENTION: Orego• law -q -s you to follow the rules adopted by the Oregon Utility Notification f ent>. • rules are set forth in OAR
952-001 /010 through OAR 95 $.:1-0090. - may obtain a copy of the rules or direct questions to OUNC by calling 503.23 . :8 or .: _ 344.
/ �' I� /
/ .
Issu=d By: 1 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 FOR mufti: i.sl: Osl.v
City of Tigard nate i3ed < /4 / Permit#:EL J ainLuh
111 u 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 1
_ Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Juris: Vi See Page 2 for
T I G%R.D 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):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
O Multi-family D Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address: j S L R J ckl 4-G 0 c,,1.N C., 100HP or more. ❑"A">"E">°°l 2">"l-s">
7 ❑Six or more residential units. occupancy.
City/State/ZIP:J 7-50 S co r c,,,,1- 1.Jc I1 _„ed (-J\{ C T Z2� _ ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: if--.31_/4'c 0 Hazardous locations. 0 Supply voltage for more than
0 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
!' �!� Q G�t ,\ (with above sq.ft.) 75.00 2
C. �GC�1 ����-�7 r )LWN � Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: (dr‘ -__-_-;0,7.1.-_n 200 amps or less 100.70 2
G,�0,1 y cm `�r.--�J
Address: /23 3 c S� aC iYt,� 11-0(_-_-'
?U 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: T1'c' p-r d /oy-.. 9 7("1_23 601 amps to 1,000 amps 301.04 2
Phone:(503) C` b 9 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 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 El CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
0
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
service or feeder fee,first 56.18 2
Address: branch circuit
City/State/ZIP: Each add'l branch circuit 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 G 7 sr 2
CONTRACTOR Pump or irrigation circle / 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: panel,alteration,or extension.
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 Lic.: Suprv.Lic.: specifically listed(Vs hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: Lv7 kft
Print name: Date: 0 Plan Review Required(25%of permit fee): -----
State surcharge(12%of permit fee): >./7
Authorized signature: / (dTOTAL PERMIT FEE: 75-.
This permit application expires if a permit is not obtained within 180
Print name: - '' Date: days after it has been accepted as complete.
Cl * 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
Description I Qty. I Each I 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:
ElBurglar Alarm 25.01 to 50 kva 301.04 2_
111 Garage Door Opener* 50.01 to 100 kva 552.26 2
>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:
I I Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/hr min)
xr
COMMERCIAL WORK ONL*; :a;. ELECtRICAL.0ElilVIIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n 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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