Permit (162) CITY OF TIGARD ELECTRICAL PERMIT
I . COMMUNITY DEVELOPMENT ELECTRICAL
ELC2019-00272
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/25/2019
T i C.A R n9 Parcel: 2S105DA17700
Jurisdiction: Tigard
Site address: 14610 SW CATALINA DR
Project: ALMANSOORI Subdivision: PACIFIC CREST Lot: 65
Project Description: Reconnect only.
Contractor: Owner: ALMANSOORI, NASSER SAIF
14610 SW CATALINA DR
TIGARD, OR 97223
PHONE:
PHONE: 503-697-7785
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 04/25/2019 $67.84
Specifics:
1 ea 12%State Surcharge- 04/25/2019 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 - other applicable law. HtN ork will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, • if work is suspended for mo: e 180
days. ATTENTION: Oregon law requires y• to I. ow the ules adopted by the Oregon Utility Notification Ce.er. Those -. . - se forth in OAR
952-001-0010 through 0A 0011 Yo/ay o.ain a cop •f the rules or direct questions to OUNC by calling 503.232.1:: • .:00.332.2344.
Issued By: i�/. ,.. dr1 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 101(01 1 1( 1 1 sl: 0\1.1
City of Tigard nate/B :
II13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
: Phone: 503.718.2439 D. Related Permit#:
Email: TigardBuildingPermits@Tigard-or.gov '-= `Rtady b ate/By: Juris: ® See Page 2 for
1 I 'ARD Inspection Line: 503.639.4175 Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
f, 0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition her �/q y YI to i^ ( q, i r'� ` 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 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 ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
1 `�\
0 Addition of new motor load of system.
Job#: Job site address: 1 C 6 Wiz(1 �[ �4kii tl 1 1:,(', 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:�� r�~+ Vw �1 1r/ 1 ❑Six or more residential units. occupancy.
ty 'V` 0 Recreational vehicle parks.
0Health-care facilities.
Suite/bldg./apt.#: Project name: i ❑Hazardous locations. 0 Supply voltage for more than
I+ 1^� t� fV.• ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: _(t�:‘,---N FEE SCHEDULE
Description I Qty. I Each I Total I *
(� New residential single-or multi-family dwelling unit.
Subdivision: t i`ce-5� Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'►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 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: I V(y Y b( nj l 1r\cok,�•�'\ 200 amps or less 100.70 2
V 1 f 201 amps to 400 amps 133.56 2
Address: !q LU' 0 ( t ,�ti-- • 401 amps to 600 amps 200.34 2
City/State/ZIP:"�' ` 601 amps to 1,000 amps 301.04 2
Phone:(/ 3)
\ �� /� Over 1,000 amps or volts 552.26 2
_ // / � Temporary services or feeders installation,alteration,and/or
Email: 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
El APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: L aG\i„ m —/n/J� � B.Fee for branch circuits without
serAddress: 1( 1 ( O w( V Co\—` \t\j 0\ �r branchce or feeder fee,first 56.18 2
`'`'`'1 branch circuit
City/State/ZIP: I „e,/�J?,7 0 q�023 Each add'►branch circuit 7.42 2
)" �J Miscellaneous(service or feeder not included
Phone:( ) -?5-- Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only Km 67.84 2
PANFRACTOR . --- .. M , , , , Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 - 2
Signal circuit(s)or limited-energy 0 See Page 2 2
Address: panel,alteration,or extension.
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
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed CA hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
A This permit application expires if a permit is not obtained within 180
Print name:` iti_____A661 t A� \ DateA 1�1 ,,,5 q days after it has been accepted as complete.
(((����7 V\ ( �✓ t / * 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 WORK QNNLY, FEE SCHEDULE
Description I Qty. I Each I Total
Fee for all residential systems combined: $75.00 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:
n 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 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 hr min)
COMMERCIAL WORK ONLY: =
ELECTRICAL PERMIT FEES
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
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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