Permit (36) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2019-00011
Date Issued: 01/29/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S103BB10000
Jurisdiction: Tigard
Site address: 12060 SW 122ND CT
Project: MASON Subdivision: YE-OLDE WINDMILL Lot: 21
Project Description: (1)bathroom exhaust fan.
Contractor: OWNER Owner: MASON, MATT&MEREDITH WINDSOR
MATT MASON& MEREDITH WINDSOR 12060 SW 122ND CT
12060 SW 122ND CT TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 209-769-4715 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 01/28/2019 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/28/2019 $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 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 952-001-0090. You may•.am a •. of the rules or direct questions to OUNC by calling 503.232.1987 or
1.800.332.2344..
Issued By: f AL- ••• mittee Signature: P
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 RECEIVE 1- l O1z OFI.ICI: Is1:ONI.I
City of Tigard 'eceived
` ear 2019 Date/B : .�� _ , .
13125 SW Hall Blvd.,Tigard,OR 97223 JAN t Plan Review
:111111 II Phone: 503.718.2439 Date/B Related Permit#: ) -C�
Email: TigardBuildingPermits@Tigard-or.govCITY OF TIGARD Ready Date/By: H See Page 2 for
T 1 G i\RI) Inspection Line: 503.639.4175 Irate t i t ftislaINEE„ • 'led/Method: A Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction 2 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑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.
® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address:
%21)C0 5-/„/ /Z 2- CT 100HP or more. ❑"A" "E» °°1-z" °°1-3"
City/State/ZIP: 1;6,e 1.."-e-, 0 t 77 2-7 j 0 Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: 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: I Z,/Si CN A,47-,96,-/7 iiuFEE SCHEDULE
Description I Qty. I Each I Total I
`"g/6 H/ 0Ai I22.avn ei'. New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
' // (with above sq.ft.) 75.00 2
NL,/ C//26 U%% fOR. ./(../,:b.} /5))<17-4/74-40/?,4 .-/jAIIA- Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Q� PROPERTY OWNER ❑ TENANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: 4.14 ! F" , 7Aj 200 amps or less 100.70 2
-. ., 201 amps to 400 amps 133.56 2
Address: O 0 /C E„,cam �� 401 amps to 600 amps 200.34 2
City/State/ZIP: /_/, ,CAD 1/�",, 77 z,Z3 601 amps to 1,000 amps 301.04 2
Phone:( 7) 76/ 1/7/[j Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: 51/141:„...') / -&s' �, Cii71 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,r- .r- •F'tinge,a .rding to ORS 447,449,670,and 01. 201 amps to 400 amps 125.08 2
.. ,
Owner signature: �,.// Date: / 7' 2 401 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
Business name: '1� GGJf above service or feeder fee,
/
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits u is w t
l hout
Address: service or feeder fee,first
Q
branch circuit 56.18sz, (r/ 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(%hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: St,,(,
Print name: Date: 0 Plan Review Required(25%of permit fee): -'
State surcharge(12%of permit fee): C ,-)y
Authorized signature: TOTAL PERMIT FEE: ti'/ 1 _gu
This permit application expires if a permit is not o tamed within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
L\Building\Permits\ELC_PennitAppELRERE.doc Rev 10/26/2017 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE,
Description I Qty I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
2
Check Type of Work Involved: 5 kva or less 133.
5.01 to 15 kva 133.5656 2 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
specifically listed 'z r mm
CO1 RCIAL WO/WC Y: A ` ;AL PE 1
�7 gin.r� v
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
y * 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
LI Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017