Permit (64) CITY OF TIGARD ELECTRICAL PERMIT
iii .., COMMUNITY DEVELOPMENT Permit#: ELC2017-00335
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/10/2017
Parcel: 2S 105DA17700
Jurisdiction: Tigard
Site address: 14610 SW CATALINA DR
Project: AL-MANSOORI Subdivision: PACIFIC CREST Lot: 65
Project Description: Electrical reconnect only
Contractor: N/A Owner: ALMANSOORI, NASSER SAIF
14610 SW CATALINA DR
TIGARD, OR 97223
PHONE: PHONE: 503-697-7785
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 05/10/2017 $67.84
Specifics:
1 ea 12%State Surcharge- 05/10/2017 $8.14
Electrical
Type of Use: SF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports(Conditions)
i
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes a • = o er .licable law. All work will
be done i • •. 6.. ith approved plans. This permit will expire if work is not started within 180 days of issuanc o ' - uspended for more the 180
days. . TENTION: Oregon law -•uire you to follow the rules adopted by the Oregon Utility Notification '-nter. Those rules are set forth in OAR
952 $01-0010 through OAR 95 •$1-00.6 You may obtain a copy of the rules or direct questions to OUNC by calling 50 .1987 or 1.800.332.2344.
I sued By: —A .'```.g4 ki Permittee Signature:
— OWNER INSTALLATION ONLY
The installation is being made on property I own whic i not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 603.639.4175 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 rolz orrice: i. is o',i.v
City of Tigard Received C / 3555
Date/B J Permit#: E�0//,
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960ill
Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Juris: H See Page 2 for
1 +G A 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.
0 Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION, exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amp❑Multi-family 0 Master builder ❑Other: Fire forallother installations. tngs.
El pump. Installation❑ of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: /1/6 (0 sU� (+‘ � ✓- 0 Addition of new motor load of system.
IOOHP or more.
City/State/ZIP: ' ie 0 P C9) 27 2 a Six It more residential units. Recreational
occupancy.
t CA ( Gam--7 Health-care facilities. ❑Rrvehicle parks.
Suite/bldg./apt.#: U Project name: r�I.L. +1 `�l/L 0 Hazardous locations. 0 Supply voltage for more than
�t600 volts nominal.
Cross street/directions to job site: 0Service or feeder 600 amps or more.
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
DESC ON OF WORK Limited energy,residential 75.00 2
e/ 6(' / �(C4 / �` 1�� � (with above sq.ft.)
C�L C /1�fv Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
0 PROPERTY OWNER i ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: A a /-j--//� V t 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address: j � 0 s + "�
l 6 � — �-� l '✓� � ✓ 401 amps to 600 amps 200.34 2
City/State/ZIP: ---"Fc1,�) 6 ?,)„..2 'J 601 amps to 1,000 amps 301.04 2
Phone:(5�2) C..)9 r 2i� Fax:( ) Over 1,000 amps or volts 552.26 2
7 Temporary services or feeders installation,alteration,and/or
Email! ( ��(.,� �0 ( G,/ o*j (1)._3„, relocation
Owner installation:This installation is'king 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
0
APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7'42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
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 67.84 2
Email: dwelling,service and/or feeder
Reconnect only / 67.84 to 7 eCL 2
CO CTOR Pump or irrigation circle 67.84 / 2
Business name: Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
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('/2 hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: Cj 7,qcz
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 9 /4/
Authorized signa TOTAL PERMIT FEE: �Q'
/ sss---��� This permit application expires if a permit is not obtained 180
Print namef 1 Date: I,A (0/ days after it has been accepted as complete.
+t * Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 j 4 I•,15T(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
DescrFee for all residential systems combined: $75.00 I Qty. I Each I Total I
3' 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:
El Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
n G• arage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
n H• eating,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:
El 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(1/2 hr min)
COMMERCIAL%W RK ONLY: ELECTRICAL PERMIT FEES
WORK
Subtotal Enteron Page 1):
Fee for each commercial system: $75.00
3' * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
El Other:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELRERE.doc Rev 06/17/2015