Permit (155) CITY OF TIGARD ELECTRICAL PERMIT
IIICOMMUNITY DEVELOPMENT Permit#: ELC2018-00802
a 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/06/2018
TIGARD 9
Parcel: 2S 104C B03000
Jurisdiction: Tigard
Site address: 13058 SW OXALIS TER
Project: Boyan Subdivision: HILLSHIRE WOODS Lot: 76
Project Description: Alteration of(2)branch circuits moved to another wall.
Contractor: OWNER Owner: DAVIS,JENNIFER C
BOYLAN,JASON BOYLAN,JASON D
13058 SW OXALIS TER 13058 SW OXALIS TER
TIGARD, OR 97223 TIGARD,OR 97223
PHONE: 503-333-5121 PHONE: 503-333-5121
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 12/06/2018 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/06/2018 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 -p,licable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of is- ance, or/ work i su-•en• • for e the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificatio Center. Those rule a e -t•h in OAR
952-001-0010 through O 52-00 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 5, .T•- •: `o' .800.3 OeWi
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Issued By: / Permittee Signatur ji "r
OWNER INSTALLATION ONLY i
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.
I
Electrical Permit Application ':it,' 4 d '��1 ': FOR OFFICE USE ONLY
City of Tigard Received _
Date/13 : a / 4lli1V•ermit#S'"(C.r. �! ; 0de®
14 = . 13125 SW Hall Blvd.,Tigard,OR 97223 ,i 7 �j
' Date/BPlan eview' Wim/--Cliff''—' *eltsr.9!
� Phone: 503.718.2439 Fax: 503.598.1960 '1�- `° Related Pe
Inspection Line: 503.639.4175 Ready Date/By: Juris El See Page 2 for
I I t1`f1 Internet: www.tigard-or.gov Notified/Method:
Supplemental Information
❑New construction 1: Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Other: where the available fault current 0 Marinas and boatyards.
�i�7 . ,, r i e r i , ' . N V, o exceeds 10,000 amps at 150 volts or 0 Floating buildings.
Iia 1-and 2-family dwelling 1=ICommercial/industrial El Accessory building less to ground,or exceeds 14,000 ❑commercial-use agricultural
❑Multi-family ❑Master builder ❑Other: amps for all other installations. buildings.
❑Fire pump. 0 Installation of 150 KVA or
b 4 `9- '4P1:4,1(.4.:_ j ' `!,,:') 1 , I d P ' ' ',.-11,-::7:'1;,. 0 Emergency system. larger separately derived
Job#: 1. Job site address: I3 , l /
❑Addition of new motor load of system.
_ - l 7XyK i �ti 100HP or more. ❑"A,> "E„ "1-z„ "1-3„
City/State/ZIP: ,1 i G%V-4 1 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.4: I Project name: ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:
Description I Qty. Each i Total I .,
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel 4: 1,000 sq.ft.or less 168.54 4
u Ea.add'l 500 sq.ft.or portion 33.92 1
/ i Limited energy,residential 75.00 2
t.. -i+MCN� moo- 4-skkeyv , Ais (Q 4 i004 (with above sq.ft.)
Limited energy,multi-family 75.00 2
Lt}_a'a ' oc e e k• 3-Ct. residential(with above sq.ft.)
n,oi , > i Renewable Energy ❑ See Page 2
; '' h.` '° ' _ r_ '-= Services or feeders installation,alteration,and/or relocation
Name: p,5 c," 1ti(,CA 200 amps or less 100.70 2
Address: I' a S? S Cox CO
S -r e -t-ac e... 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: '" ( 0( 601 amps to 1,000 amps 301.04 2
Phone:(,C3) 3-5t 512_1 Fax:( ) Over 1,000 amps or volts 552.26 2
Email:
Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is bein• made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease - . .e•--,according to ORS 447,449,670,a 7 1. 201 amps to 400 amps 125.08 2
Owner signature: arm ' _Date: i 3 i l 401 amps to 599 amps 168.54 2
_ � = �� Branch circuits-new,alteration,or extension,per panel�'` �1P1 � � ,? ® �ii �hs�., A.Fee for branch circuits with p
Business name: / above service or feeder fee,
Contact name:
each branch circuit 7.42 2
CN\ GZ B.Fee for branch circuits without
service or feeder fee,first
Address: 'ilo D -t7O�.;,/ 56.18 2
c _l branch circuit
City/State/ZIP: l�;r � t., ,,�-�,���` CAL �i GI Each add'l branch circuit I 7.42 2
t"u CAL v 1 Miscellaneous(service or feeder not included)
Phone:( ) 3 v 1 t A 1-3 Fax: :( 3) -cO 3,1 Li 7 3 Each manufactured or modular
Email: J i �� 0_,010...1.-(...41+-4..r, t�� 7 dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
: ; y '
- � �.�, �,�1:_ � C j 4 4 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:( ) Fax:( ) Investigation(1 hr min) - 90.00/hr
Email: Industrial plant(1 hr min) 111. 78.18/hr
Inspections for which no fee is ■
CCB Lic.:St(pb S 3- Electrical Lic.: Suprv.Lic.: s iecifically listed CA hr min) 90.00/hr
Suprv.Electrician signature,required: '`
Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee): Z
"'4� State surcharge(12%of permit fee): -
✓ TOTAL PERMIT FEE:
Authorized signature040.,., t,
This permit application expires if a permit is not obtained within
Print name: JAI x �....... ' Date: ['"j ez. / days after it has been accepted as complete. AVIV
.s,...-
G / * Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp LR_ERE.doc R. 0. 7/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
jii,[nriTVT'MMTPNMW7TAPV:Rd ,'- it* a
Fee for all residential systems combined: $75.00 Description Qtr. Each I TotalI *
Renewable 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
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ 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: chap ed ataddithourly(1 hr min)onal inspection is
66.25/hr 1
g y
Inspections for which no fee is 90.00/hr
specifically listedV2 hr
(' i
ta
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
❑ 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 06/17/2015