Permit (30) CITY OF TIGARD
COMMUNITY DEVELOPMENT
ELECTRICAL PERMIT
+� Permit ermit#: ELC2018-00181
T f r;A Ir.f) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/15/2018
Parcel: 1 S134AA01100
Jurisdiction: Tigard
Site address: 11348 SW IRONWOOD LOOP
Project: NELSON Subdivision: ENGLEWOOD
Project Description: Replacing(1)200 amp service panel and(6)branch circuits. Lot: 18
Contractor: G&H ELECTRICAL CONSULTING LLC Owner: NELSON, JENNI
PO BOX 12901 11348 SW IRONWOOD LOOP
SALEM, OR 97309 TIGARD OR 97223
PHONE: 503-302-3354 PHONE:
FAX:
FEES
Quantity Description Date Amount
Specifics: 1 ea Services or Feeders-200 03/15/2018 $100.70
amps or less
6 crt Branch Circuits w/Purchase 03/15/2018 $44.52
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 03/15/2018 $17.43
Type of Const: Electrical
Occupancy Grp:
Total $162.65
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 95,1-009#. You obtain a co- of the rules direct questions to OUNC by calling 503.232.1987 or 1.800.382.2344.
Issued By:
:"Ir Permittee Signature: L. r .n-A ./
f, _
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 orrlcl. I:SE("II
- City of Tigard Received
13125 SW Hall Blvd.,Tigard,OR 97223' r; Date/B :Phone: 503.718.2439 a Plan Review
II
Date/B Related Permit#:
T I G A!Z D Email: TigardBuildingPermits@Tigard-or.gcfv ' Ready Date/By: Juris,
Inspection Line: 503.639.4175 Interned g g See Page 2 for
Www.ti and-or, ov Notified Method: Supplemental Information
E OF WORK PLAN REVIEW
0 New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
0 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.
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.
❑Multi-family 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#: 11_(� I Job Site address: '3 �'�� W J ❑Addition of new motor load of system.
t r-0 0 Dot; L l00HP or more. ❑"A","E","I-2","I-3",
City/State/ZIP: ---1--1 6 � j
f 0 !1 p 7 �- ❑Six or more residential units. occupancy.
'` 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: ElHazardous locations. 0 Supply voltage for more than
Cross street/directions to job site: ❑Service or feeder 600 amps or more. 600 volts nominal.
FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
DESCRIPTION OF WORK Ea.add'l 500 sq.ft.or portion 33.92 1
Limited energy,residential
C%� Gill�Q (i( 'T 01A pG /1�� (withsq.ft.)
T j bdt 1!-'0v ill' �� above 75.00 2
/ Limited energy,multi-family
a u'ree'je 0 p i�( Fi lel. 1 n ,14,i� L residential(with above sq.ft.) 75.00 2
V 0 PROPERTY WNER V ID ANAAANN'�jT� 7 Renewable Energy 0 See Page 2
Name: Te.H i2 f
Services or feeders installation,alteration,and/or relocation
' ,AV/cISl1V1 200 amps or less I 100.70 2
Address: 201 amps to 400 amps 133.56 2
City/State/ZIP: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) 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
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 am25.08 1
Ps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54
2
PPLICANTONTACT PERSON Branch circuits-new,alteration,or extension,per panel
Business name:
A.Fee for branch circuits with
above service or feeder fee, �'
Contact name: i �,� /
each branch circuit lf� 7.42 2
£2 IA i I Q-j� 'I c c( Cc v7 S„/ ,(,,,,a B.Fee for branch circuits without
Address: C2 \ ��rX 29 1(,) i service or feeder fee,first
branch circuit 56.18 2
City/State/ZIP: S 0,, ) QNB r (0le CI
-7 3 0 Each add'l branch circuit 7.42 2
Phone:(E ab) Q. _ (J Miscellaneous(service or feeder not included)
-/ Each manufactured or modular
Email: �(' (^ 1 • dwelling,service and/or feeder 67.84 2
" v ' I ,e_1,--.1-1 Cal 01 Reconnect only 67.84
CONTRACTOR 2
Pump or irrigation circle 67.84 2
Business name:_c_.....e,,,,",. a 6ur=
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
Phone:( )
Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
/•' Inspections for which no fee is
CCB Lic.:02O tyg2 1, Electrical Lic.: C.(l! 73, I Suprv.Lic.: 59'as specifically listed(%2 hr min) 90.00/hr
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES
Print name:1����,,�__ Subtotal:
�"'v`1 L Date: g) j 5/1 O 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
IPrint name: I This permit application expires if a permit is not obtained within 180
Date: 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:
ItERIANTIAL WORK ONLY: FLEE
SCHEDULE
Description I 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
❑ 15.01 to 25 kva 200.34 2
Audio and Stereo Systems*
Wind generation systems in excess of 25 kva:
n 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
n >100 kva-no additional charge 0.0 3
Vacuum Systems*
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('/hr mm)
. r : ek#
�. 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
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ 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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