Permit (129) CITY OF TIGARD ELECTRICAL PERMIT
.11111
COMMUNITY DEVELOPMENT Permit#: ELC2018-00190
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/21/2018
Parcel: 2S 110AB00800
Jurisdiction: Tigard
Site address: 14275 SW 112TH AVE
Project: STOKES Subdivision: COLE'S ACRES
Project Description: Panel replacement. Lot: 6
Contractor: OWNER Owner: STOKES, LE TRUST
RICHARD STOKES 16365 SW 137TH
STOKES, LE TRUST TIGARD, OR 97224
16365 SW 137TH
TIGARD, OR 97224
PHONE: 503-590-5505 PHONE:
FAX:
FEES
Quantity Description Date Amount
Specifics: 1 ea Services or Feeders-200 03/21/2018 $100.70
amps or less
1 ea 12%State Surcharge- 03/21/2018 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or ' " .rk su>•ended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cente. r .
952-001-0010 through 0 952-001-0090. Y ru rs are set forth in OAR
r'0��= Y•�or direct questions to OUNC by calling 503.2 2 �:7 or 1.��r 2.
Issued By:
�--�_ C?,yS •i�/
Permittee Signature: - " °
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE
Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC'
Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application -- a�..
n, FOR OFFICECSG 011.1'
City of Tigard ,; -.
t Received
�rr Date/B : ,� t/� Permit#: _ ..,` . ",- / 41�
71
13125 SW Hall Blvd.,Tigard,OR 9713 .»
= Phone: 503.718.2439 Plan Review
Date/B Related Permit#:
T I G A R D Email: TigardBuildingPelmits@Tigard-or.$ovry -, ,_�l •t Ready Date/By: H See Page 2 for
Inspection Line: 503.639.4175 Internet: iV .t rand-or.gov , Notified/Method: /i Supplemental Information
TYPE OF WO r V ( a' It1r t�
o New construction :r i ...r, , PLAN REVIEW
�Addition/alteratlbn l•epgl enI � Please check all that apply(submit 2 sets of plans w/items checked):
t ' '"'ti' 0 Service or feeder 400 amps or more 0 Building over three stories.
El Demolition 0 Other
Yli�' where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
,�,�
Ly'1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑Multi-familyamps for all other installations. buildings.
0 Master builder 0 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: f� ZT i c jvJ i(�1t ,. 2,-.2./`) ❑Addition of new motor load of system.
t100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: �^ A } <_ 70 Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: / —Tic-1,,,'/--1 /�J
Pr Sect name: [ t O1 1 (.,. 0 Hazardous locations. 0 Supply voltage for more than
f
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: cif vo t'
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
G e CJ1 t{"s/ii .11) 6-%l e e7 re (with above sq.ft.) 75.00 2
'/ � ( Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
PROPERTY OWNER 0 TENANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: t_G i /c1�� 200 amps or less I 100.70 2
Address: J.t , 3". Sti/k./ 1 2 / — WI 201 amps to 400 amps 133.56 2
_�/ ) 401 amps to 600 amps 200.34 2
City/State/ZIP: J (/e, q,3 ��
601 amps to 1,000 amps 301.04 2
Phone:(5,-7.2 . s/ a_s71-0-11--- Over 1,000 amps or volts 552.26 2
Email: 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,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
L
Business name: 444N. � c4?
9� ' 'ty- PIA-)1:3, C./...4.4 above service or feeder fee,
Contact name: n r ti
each branch circuit 7.42 2
B.Fee for branch circuits without
Address: Lc 's e - / 3.!J t',J service or feeder fee,first
—7-S:7
,G/,-, branch circuit 56.18 2
City/State/ZIP: / /� %1�uiv C" -2 2-y">// Each add'l branch circuit 7.42 2
Phone:( ji i <>4 s � f / l � Miscellaneous(service or feeder not included)
Each manufactured or modular
Email: dwelling,service and/or feeder
67.84 2
Reconnect only 67.84 2
ONTRACTOR Pump or irrigation circle 67.84 2
Business name: I��,�/
_i 1�` ter, de¢ �� Sign or outline lighting 67.84 2
Address: 6 D Signal circuit(s)or limited-energy
t/ t/y 3 / �i1 panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: —�^�� Acz, J Dir ) �,//` Each additional inspection over allowable in any of the above
!_ Additional inspection(1 hr min
Phone: - )) �' -r p ) 66.25/hr
�S t� , J Investigation(1 hr min) 90.00/hr
Email: / Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 711 6 Electrical Lio.: / C;4br Sup ic.: specifically listed(Y hr min) 90.00/hr
Suprv.Electrician signature,required: 12/---/./97,?/J4—,/' .1 / ELECTRICAL PERMIT FEES
` L .�' -7 Subtotal:
Print name: l `n l(�U" ��
tC�"�L7040 < 0,g Vis-' Date: j 2,,pr 0 Plan Review Required(25%of permit fee):
J,r) State surcharge(12%of permit fee): /a OS
Authorized signature: TOTAL PERMIT FEE: /12-2 y�
t C/ !/ / �r )I This permit application expires if a permit is not obtained within180Print name: /L. .� Date: J `' )/1 Ir
T�d�— �� ��� J days after it has been accepted as complete.
* Number of inspections allowed per permit.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
IITETTIAL WORK ONLY FEE
E
�Nv�: Description S CHEDULI Qty. I Each 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
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
ri 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)
n Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
>100 kva—no additional charge 0.0 3
n Vacuum Systems*
Each additional inspection over allowable in any of the above:
❑
Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/z hr min)
CO 1 iI R�CIAL''W O `ONL.'. = u
ELECTRIC L",PERMITFEES ..
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
Fl Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
In Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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