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Permit
CITY OF TIGARD ELECTRICAL PERMIT 2. COMMUNITY DEVELOPMENT Permit#: ELC2018-00013 Date Issued: 01/08/2018 Ti C ,1 Ft D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104AA03200 Jurisdiction: Tigard Site address: 12160 SW 126TH AVE Project: WYFFELS Subdivision: BELLWOOD Lot: 34 Project Description: Panel replacement. Contractor: CONDUIT ELECTRIC Owner: HENRY&ROSE WYFFELS 19461 SW 89TH AVE 12160 SW 126TH AVE TUALATIN, OR 97062 TIGARD, OR 97223 PHONE 503-692-1428 PHONE: 503-680-6776 FAX: 503-692-3652 FEES Quantity Description Date Amount 1 ea Services or Feeders-200 01/08/2018 $100.70 Specifics: amps or less 1 ea 12%State Surcharge- 01/08/2018 $12.08 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Yg ..- ••t - opy o =rules or direct questions to OUNC by calling 03.232.1987 or 1.8'+• . ,'.2344. r+f.4.jt4, Issued By: (f1��, f Permittee Signature: C' VP 0 , 74 i� / 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 OFFICE USE ONL\ City o Tigard ,j -.f r „ed , , `J f g D y t ... ..3::I �.f Permit •#: `) ,� - 0 O III * 13125 SW Hall Blvd.,Tigard,OR 97223 , Phone: 503.718.2439 ' ° 'evie Related Permit#: Date/B Email: TigardBuildingPermits@Tigard-or.gov Ready Date/By: ®� ® See Page 2 for T I G A R D Inspection Line: 503.639.4175 Internet: www.ti or.g% '2.i l ll Notified/Method: E - Supplemental Information ..; TYPE OF WORK ',,, ,j i`TI.�'+. PLAN REVIEW 0 New construction ddition/alteration/reltllin(eri A D Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more 0 Buildin over three stories. EI Demolition El Other: a :‘ (€'Iv )1 K�. ' g ] ` ' ( where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ,gi..1-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. ❑ Fire Multi-family 0 Master builder 0 Other: ❑ pump. 0 Installation of 150 KVA or JOB SITE INFORMATION:AND LOCATION 0 Emergency system. larger separately derived j / 0 Addition of new motor load of system. Job#:1i'/ `i✓ Job site address: / - 1 h�© s'� /e i � 1 OOHP or more. ❑"A" "E" "1-2" ``1-3" City/State/ZIP: / /�/l " " ❑Six or more residential units. occupancy. ` t/9�� V \ o�,( ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: i/ Project name:% '� Siyear,i j^ .r 0 Hazardous locations. 0 Supply voltage for more than �- (/" D t ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: z� FEE SCHEOU E 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'1500 sq.ft.or portion 33.92 1 .;,' DESCRIPTII N-OF:„WORK 4 energy,residential e Limited 75.00 2 f ,w,, (with above sq.ft.) fi'//Ge `et..CE e• eAi Limited energy,multi-family residential(with above sq.ft.) 75.00 2 Renewable Energy 0 See Page 2 kROPERTY OWNER;` }” 0 TENANT Services or feeders installation,alteration,and/or relocation � � Name: e , 6, ,/" ..)../..c.„ f f � _r ,f 200 amps or less 1 100.70 toe ;70 2 Address: f 1 0 �G / 201 amps to 400 amps 133.56 2 ty /ZI / �/ �5 401 amps to 1,6 0 amps amps 200.341 2 Ci /State/ZIP:" 601 amps to 1,000 301.04 2 Phone:, ?) 4s 6 7-2 6 Over 1,000 amps or volts 552.26 2 f�_ / ^ kv-mom i', / �� Temporary services or feeders installation,alteration,and/or Email: r (�/ - relocation Owner installati :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 ❑' 'PLICANT .:'. . 0 CO TACT PERSON ., Branch circuits-c new,alteration,or extension,per panel �.A / 7e- ('C A.above for branch feeder wet, Business name: ��:Gi�A /Gl/ above service or feeder fee, 7.42 2 / each branch circuit Contact name: C" �� v h_,J- / �1.-- �!- B.Fee for branch circuits without Address: / / S'(�/ Q j s service or feeder fee,first 56.18 2 YGa / branch circuit City/State/ZIP: / ��/ i� vZ Z,/e c?7 ‘ Each add'l branch circuit 7.42 2 rMiscellaneous(service or feeder not included) Phone: n. ) C7 2 -72g Each manufactured or modular 67.84 2 Email: C�1 �^ C-62/-7,-,Z,,,, Xe-'4,:.:,7:,-/c- dwelling,service and/or feeder 7 , C,),.4-7 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. 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:( ) 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.:%(,29 �Electrical Lic.:�( —9'OS Cf'- Suprv.Lic.: X5-6V specifically listed CA hr min) ELE,TRICAL''PERMIT.FEES ' Suprv.Electrician signature,required: Subtotal: 7u Print name:4,,/74.---/&,,s ciit' Date:/- r% -/7 0 Plan Review Required(25%of pennit fee): State surcharge(12%of permit fee): f j d,Lf Authorized signature: TOTAL PERMIT FEE: 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 10/26/2017 440-46151(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: r >, FEE SCHEDULE Description I Qty. I Each I Total I * 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 n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: n B• urglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 n Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 ri H• eating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 n Vacuum Systems* >100 kva-no additional charge 0.0 3 Each additional inspection over allowable in any of the above: n O• ther: 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) COMMERCIAL WORK ONLY: ... ELECTRICAL'PER114IT FEES" ti ; . 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 n Boiler Controls ❑ Clock Systems n Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC n Instrumentation ❑ Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical n Nurse Calls ❑ Outdoor Landscape Lighting* n Protective Signaling n Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 10/26/2017