Permit CITY OF TIGARD ELECTRICAL PERMIT
IIIII1 ' COMMUNITY DEVELOPMENT Permit#: ELC2018 00613
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/24/2018
T[ att[�.0 g Parcel: 2S114BB08900
Jurisdiction: Tigard
Site address: 16264 SW 104TH AVE
Project: Lange Subdivision: SWANSON'S GLEN Lot: 30
Project Description: (1)panel and(8)branch circuits for addition.
Contractor: OWNER Owner: LANGE, NIXON
NIXON LANGE 16264 SW 104TH AVE
16264 SW 104TH AVE TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 971-333-1170 PHONE: 971-333-1170
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 09/19/2018 $100.70
Specifics: amps or less
8 crt Branch Circuits w/Purchase 09/19/2018 $59.36
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 09/19/2018 $19.21
Electrical
Type of Const:
Occupancy Grp:
Total $179.27
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 R 952-001-0090. You You ma obtain co• • he rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: :"—v,C,42,-06.—.— ... Permittee Signature: CF;)mac. ✓ � ��-
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 .SI:ON I.1
CityofTigard Received �.
gra ,,., t
IIIq 13125 SW Hall Blvd.,Tigard,OR 9722 " Plan Review
C Phone: 503.718.2439 Date/B : Related Permit#: "'--- 1 (_I),;ifK
Email: TigardBuildingPermits@Tigard-or.goC p �1 Ready Date/By: EOMn See Page 2 for
7 I G A K D Inspection Line: 503.639.4175 Internet: vv tig d- r. I Notified/Method: Supplemental Information
TYPE OF Wo `1i'OF TIGARD 3 . . PLAN REVIEW
New construction Addition/alt f Please check all that apply(submit 2 sets of plans w/items checked):
❑ � �� �
El Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition ❑Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
4 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.
O Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address: jjrli a)/ l/ /� ❑Addition of new motor load of system.
l [Cf. A [
V-_. 100HP or more. ❑`<A> `<E„ <1.2„ `l_3„
City/State/ZIP: /� Q ❑Six or more residential units. occupancy.
i`'mel f G 11 i7 Zz- ❑Health-care facilities. 0 Recreational vehicle parks.
/ �� ❑Hazardous locations.
0 Supply voltage for more than
Suite/bldg./apt.#: Project name: Loyv. ric- i,4/.
i' l` ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: L .,i kcL,v– FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: c l„,..,7C^R).�, e. ,\ Lot#: ' c-) Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
NI PROPERTY OWNER TENANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: 1\1;x6 ri Le`tv`' t 200 amps or less I 100.70 lad - 2
Address: ((z Y c,(a� t 0 y /`, , 201 amps to 400 amps 133.56 2
T`^'° 401 amps to 600 amps 200.34 2
City/State/ZIP: ,--77:1 ,,,k ( 0 K co 2:7.1 601 amps to 1,000 amps 301.04 2
Phone:(��`) --i U Over 1,000 amps or volts 552.26 2
+ Temporary services or feeders installation,alteration,and/or
Email: Act I cut t n\m‘,,,,k ,L N& relocation
Owner instillation: is insta atio s /ei • made on property that I own which is not 200 amps or less 59.36 1
intended for sale,le. iiit,or excha`�, cordin• to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: /A / Date:.”—/F–'/g 401 amps to 599 amps 168.54 2
I APPLI 1 0 CONTACT PERSON Branch circuits–new,alteration,or extension,per panel
A.Fee for branch circuits with p
Business name: above service or feeder fee, D
each branch circuit 7.42 SI.A.,, 2
Contact name: N i k On < <y�„ • B.Fee for branch circuits without
service or feeder fee,first
Address: O
Q/A-.L. branch circuit 56.18 2
City/State/ZIP:
Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: 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 ❑ See Page 2 2
Address: panel,alteration,or extension. g
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
Industrial plant(1 hr min) 78.18/hr
Email:
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed('V hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: i(i(;,( j
Print name: Date: ❑Plan Review Required(25%of permit fee):
ri
Authorized signature.`
State surcharge(12%of permit fee): t� j
v /,,,..4
�Sl�� TOTAL PERMIT FEE:
Ai
`ICr This permit application expires if a permit is not tained within 180
,^
Print name: 'V S rl Z J Date: g--Z?w !5 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:
RESIDENTIAL WOW( FEE SCIIED L .# 5
*
Fee for all residential systems combined: $75.00 nese 0 RenewaEachI electrical energy systems.
Check Type of Work Involved: 5 kva or less 100.70 2
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:
❑ 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
specificall listed('A hr min)
CO0 ERC r ® r,. ». . PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
* 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
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017