Permit (207) CITY OF TIGARD ELECTRICAL PERMIT
`° e. COMMUNITY DEVELOPMENT Permit#: ELC2018-00157
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/05/2018
Parcel: 2S103CD08900
Jurisdiction: Tigard
Site address: 13543 SW PIPER TER
Project: Culver Subdivision: 2008-074 PARTITION PLAT Lot: 2
Project Description: Altering(1)existing branch circuit for a patio cover chandelier.
Contractor: OWNER Owner: CULVER,WILLIAM R&CHERYL D
WILLIAM CULVER 13543 SW PIPER TER
13543 SW PIPER TER. TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-329-5468 PHONE:
FAX:
FEES
Quantity Description Date Amount
Specifics: 1 crt Branch Circuits wo/Purchase 03/05/2018 $56.18
Service or Feeder
1 ea 12%State Surcharge- 03/05/2018 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of nce, or if w•
days. ATTENTION: Oregon law requires � p- r for more the 180
AR
9 q you to follow the rules adopted by the Oregon Utility Noti cation Center. T�e rules are -et forth in OAR
952-001-0010 through OAR 952-001-0090 • na ob -copy of r-rules or direct questions to OUNC by calling !3.232. •;,7 orrr1 4.332.2344.
Issued By: Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application
;.1
FOR OFFICE USE ONLY
City of Tigard '� * Received r
. q .- 4 . Date/BY: 3 J f Penni":
13125 SW Hall Blvd.,Tigard,OR 97 ,,, Plan Review �l���rll 7
Phone: 503.718.2439 Fax: 503.598.1 �a, DateBy: Related Permit#: ST C/7-tvx
T 1 CiAKD Inspection Line: 503.639.4175 0 _Ready Date/By:: tads: Ed See Page 2 for
Internet www.tigard-or.gov nt` IIlottfied/Method Supplemental Information
__ a- L '.- STM„{ a„ +O: O� ,t r ni. T'r y .. aa 7 ,. i �r -fir,LAN .e 7" i }
❑New construction RI Addition/alteration/r li3 C"le k 4$ Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other: v� L ❑Service or feeder 400 amps or more ❑Building over three stories.
r_ li ) where the available fault current 0 Marinas and boatyards.
l'a - „ � GO� . a , tel'a 0 ' 0.'i6 exceeds 10,000 amps 150 volts or
U P 0 Floating buildings.
g1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 El Commercial-use agricultural
El MUltl famll amps for all other installations. buildings.
y ❑Master builder ❑Other 0 Fire pump. 0 Installation of 150 KVA or
.1 _ Y i" ❑Emergency system. larger separately derived
Job#1\151 -20r7-3s 5Job site address:( jy3 S J 1 ❑ 00 P o of oew motor load of system.
�� 1�/ 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: Ts R 46 a t0 41^ 224 ❑Six or more residential units. occupancy.
` J 0 Health-care facilities. ❑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: INrS vitys Lucy) o4+Si-
t
1'2-1 Description 1 Qty. Each I Notal 1
J 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
"°'tl < V _ ' -° ESCRI ':Jq I " .. r = ! P Limited energy,residential
N � (with above sq.ft.) 75.00 2
I aL rte%C CIA 7Le I Y �N b"LA� Limited energy,multi-family
'�► ( �i�(`C Y'G1 A V S 141 '�L�( residential(with above sq.ft.) 75.00 2
11,74:45r.,
`' i. 'R 'CNVRrr . ,, i = Renewable Energy ❑ See Page 2
°� `` 7M_pP*I�A' Services or feeders installation,alteration,and/or relocation
Name: V kI AMV1 C AI vret 200 amps or less 100.70 2
Address: m S'(1,3 Sv3 ft1e r rev., 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Ti Colle_IN ' tv ai ZZ 1 601 amps to 1,000 amps 301.04 2
Phone:(3j3) 375k .syer Fax:(c43) 4 Lot -1-rvi,..- Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation: t' . . . on'- being made on property that I own which is not 200 amps or less 59.36 1
intended for sa , ease,rent exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: � _41'd Date: .314/II 401 amps to 599 amps 168.54 2
°fir' 1 .ppb r t,4 . 0 t Nx E i ,i, a " Branch circuits-new,alteration,or extension, •er 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 , jry' 2
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
Email: dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
"R k 'r- qMP _ i 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.: speclficall listed(%2 hr min) 90.00/hr
Suprv.Electrician signature,required: 7_, L Yg 4 '
Subtotal: c_L i
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): C 7`
Authorized signature: TOTAL PERMIT FEE: ` 4) ../
This permit application expires if a permit is not o tained within 180
��(
Print name: �`i"t �
\taf Date:4('I i days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-4615T(11/05/COM/WEB