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Permit (38) CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2017-00497 13125 SW Hall Blvd.,Ti Date Issued: 07/03/2017 T[ta; .T and OR 97223 503.718.2439 9 Parcel: 2S 103C 600900 Jurisdiction: Tigard Site address: 13085 SW 124TH AVE Project: Wilhelm Subdivision: None Lot: None Project Description: (1)branch circuit for proposed heat pump or a/c. Contractor: OWNER Owner: WILHELM, MICHAEL W LIVING TRUST MICHAEL W WILHELM BY WILHELM, MICHAEL W TR 13085 SW 124TH AVE 13085 SW 134TH AVE TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503-590-4495 PHONE: 503-590-4495 FAX: FEES Quantity Description Date Amount 1 ea 12%State Surcharge- 07/03/2017 $6.74 Specifics: Electrical 1 crt Branch Circuits wo/Purchase 07/03/2017 $56.18 Type of Use: SF Service or Feeder Class of Work: ALT Type of Const: Occupancy Grp: Total $62.92 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. AT TION: Or-:.n law r- • -s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001 010 through OAR 9 -0$ -0090. Azi I may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19987�orr11.800.332.23444 Issu d By: Permittee Signature: )(1/4 -LL- yYifC/ OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or re . OWNER'S SIGNATURE / `-����;; G�e2-C1- c . Tib/ Date: //%7 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 Applicatio 11`ECrolz orrice. lsr.oil.) _EE Received , IICity of Tigard 7M�A`� Permit#: e:46.1)19/7....00 y j • 13125 SW Hall Blvd.,Tigard,OR 97223 Date/B C Plan Review Phone: 503.718.2439 Fax: 503.598.1968 u+ 3 Related Permit#: L Date/B Inspection Line: 503.639.4175 7���7 ReadyDate/By: H See Page 2 for I I G n It D Jurist Internet: www.tigard-or.gov Notified/Method: Supplemental Information E OF ! '1 OF TIGARD lvatPLAN REVIEW ❑New construction Addition/.t': . /MG/VISION 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 0 Other: CATEGORY OF CONSTRUCTION where the available fault current 0 Marinas and boatyards. exceeds 10,000 amps at 150 volts or 0 Floating buildings. vi and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. Multi-family 0 Master builder 0 Other: 0 Fireum P P• ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: Job site address: /349 5 J 6(1 /c;14 4-1(e-, ❑Addition of new motor load of system. 100HP or more. ❑"A","E","1-2","1-3", City/State/ZIP: / +. s' 0 Six or more residential units. occupancy. 1 /`^ A 0) 7 v'c ' _S 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: 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: A Tv\9 . S-I- Lt.:i L.H- Lei 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 Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION'OF WORK Limited energy,residential l�,t;144- h,4-- a— .4 etz �, -z.- * � � (with above sq.ft.) 75.00 2 G' Limited energy,multi-family 75.00 2 L- 4^4.44-c" e'zi c74-Q-C4, .5.- - l P,f,,, (E' residential(with above sq.ft.) [PROPERTY OWNER 0,;TENA /A Renewable Energy 0 See Page 2 I � / Services or feeders installation,alteration,and/or relocation Name: /J7 'c 1 e-L Lci- +(J C L/. G L Jn 200 amps or less 100.70 2 Address: /3 0 5 {,,J. t `0.4. rs 201 amps to 400 amps 133.56 2 ,./ 401 amps to 600 amps 200.34 2 City/State/ZIP: 'r , .. Y'J� 0y- 7 601 amps to 1,000 amps 301.04 2 Phone:(`, j 1 5, 2 ¢.4 q ✓ Fax:( ) Over 1,000 amps or volts 552.26 2 Email: /j5,,llc l<I-e-F.F 1 7-Ze e Om c m i.,-/-414/e4- Temporary services or feeders installation,alteration,and/or 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,I rent,or exchange,�accordiing to ORS 447,449,670, d 701. 201 amps to 400 amps 125.08 2 Owner signature: 1/"�!�n e&)7� ie''-,--. Date: 7 7 <2©i 7 401 amps to 599 amps 168.54 2 APPLICANT 1 (l CONTACT per;' 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 �/ branch circuit 56.18 5C4�,/4S 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: serviceand/or feeder Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: 0&t Sign or outline lighting 67.84 2 Address: L�j 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(I hr min) 78.18/hr Inspections for which no fee is CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(%=hr min) 90.00/hr Su rv.Electrician si ELECTRICAL PERMIT FEES P gnature,required: Subtotal: Pi 6 , i Print name: Date: 0 Plan Review Required(25%of permit fee): - State surcharge(12%of permit fee): (,,7 41 Authorized signature: TOTAL PERMIT FEE: /i7 9. ., 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 Description 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: 133.56 2 5.01 to 15 kva ❑ 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 ❑ 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(1/2 hr min) EL e�LPERMIT FEES COMMERCIAL WORK ONLY; 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: ❑ Audio and Stereo Systems [1 Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation El Intercom and Paging Systems El Landscape Irrigation Control* ❑ Medical ❑ 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 I:\Building\Permits\ELCPemtitApp_ELR_ERE.doe Rev 06/17/2015