Permit (48) CITY OF TIGARD ELECTRICAL PERMIT
2 . . COMMUNITY DEVELOPMENT Permit#: ELC2017-00343
13125 SW Hall Blvd.,Ti Date Issued: 05/11/2017
T[ 1 td.L and OR 97223 503.718.2439 9
Parcel: 2S112CB13300
Jurisdiction: Tigard
Site address: 14896 SW KENTON DR
Project: CUSTOVIC Subdivision: ASHFORD OAKS NO.3 Lot: 142
Project Description: Relocating(1)light switch.
Contractor: OWNER Owner: CUSTOVIC, ZLATAN&LEJLA
ZACK CUSTOVIC 14896 SW KENTON DR
14896 SW KENTON DR PORTLAND, OR 97224
TIGARD, OR 97224
PHONE: PHONE: 503-939-7569
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 05/11/2017 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 05/11/2017 $6.74
Type of Use: Electrical
Class of Work:
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all •her applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if wo is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow 1,11e._rules adopted by the Oregon Utility Notification Center. Th• .- • -s are set forth in OAR
952-001-0010 through OAR 952-001-0090, You may obtai copy of th rules or direct questions to OUNC by calling 503.232.1987 or 1.800. '4.
Issued By: , Permittee Signature: \
OWNER INSTALLATION ONLY 1.0,AIR
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application l OR 0[1'1( L t sl: oyl.l
City of Tigard �®
13125 SW Hall Blvd.,Tigard,OR 97223 \ Date/B : fi
Phone: 503.718.2439 Fax: 503.59C Plan Review
Date/B Related Permit#: ,'i
Inspection Line: 503.639.4175 Ready Date/By: See Page 2 for
I I G A R D
Internet: www.tigard-or.gov V\ Notified/Method: Supplemental Information
kV q • t 11
Vt
TYPE OF WORK 1,10 1 r.&w PLAN REVIEW
❑New construction ❑Addition/alteration/rre�p �`�. CV - Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition 0 Other: CF `$] 'i 0 Service or feeder 400 amps or more 0 Building over three stories.
Y where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTR a ivy exceeds 10,000 amps at 150 volts or
0 Floating buildings.
❑ 1-and 2-family dwelling 0 Commercial/indu' 14 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
0 Multi-famil amps for all other installations. buildings.
y ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND.LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: (n S ��q.1 ,6 r i ❑Addition of new motor load of system.
Ttr�� r 100HP or more.
\K ❑"A","E","1-2","1-3",
City/State/ZIP: \ (k4:2_..* . cy — 2 0 Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: C01--CDN)LC 0 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 Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
DESCRIPTION OF WORK Ea.add'I 500 sq.ft.or portion 33.92 1
6-2C `e-[n AL C L: ft Limited energy,sq.residential
1��j \1 (with above ft.) 75.00 2
��,�Qof _ Limited energy,multi-family
'�
TISK`-- E t- (/\)C, residential(with above sq.ft.) 75.00 2
0 PROPERTY OWNER 1 0 TENANT Renewable Energy 13 See Page 2
^, _ ,�.�� 1� Services or feeders installation,alteration,and/or relocation
Name: (k� 200 amps or less 100.70 2
Address: k l p S-j ' —TOfV -a-- 201 amps to 400 amps 133.56 2
'—t� 6s b t 401 amps to 600 amps 200.34 2
City/State/ZIP: r —y41-1--,2.(2.--(-1601 amps to 1,000 amps 301.04 2
Phone:(c,& )41c1-- , @") Fax:( ) Over 1,000 amps or volts 552.26 2
Email: -"A-Ck---a ► ---C- .�l kC:_ (t(,i ' L•GQ/ .-J Temporary services or feeders installation,alteration,and/or
_ relocation
Owner installation:This i t. .I ation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,r-, , xc ange,according to ORS 447,449,670,an 70 . 201 amps to 400 amps 125.08 2
Owner signature: IrDate: r I 401 amps to 599 amps 168.54 2
0 APPLICANT I 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
Contact name:
each branch circuit 7.42 2
B.Fee for branch circuits without
Address: service or feeder fee,first
branch circuit J 56.18 J z--�4,Ity 2
City/State/ZIP: Each add'l branch circuit 7.42 2
Phone: Miscellaneous(service or feeder not included)
( ) Fax: :( ) Each manufactured or modular
dwelling, 67.84 2
Email: service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy
panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 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
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(V2 hr min) 90.00/hr
Su rv.ElecMcian si ELECTRICAL PERMIT FEES
p gnature,required:
Subtotal: .S 6., L If
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): �0 71.
Authorized signature: TOTAL PERMIT FEE: ( q
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_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 Each I Qty. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved: 5.01 to 15 kva 133.56 2
TI 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
❑ 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 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('h hr min)
...:_ Et F��TRiCr�L. rER14n`1'N,FEESY ' � .. ,:
'COMMERCIAL ONLY:- ;z Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
El Other:
Total number of commercial systems: —
*No licenses are required. Licenses are required for all
other installations
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