Permit (157) CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit#: ELC2019-00277
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/29/2019
Parcel: 2S 111 D B 12300
Jurisdiction: Tigard
Site address: 15265 SW 94TH AVE
Project: ALSMAN Subdivision: SUMMERFIELD NO.12 Lot: 650
Project Description: Panel replacement.
Contractor: FUZION ELECTRIC LLC Owner: ALSMAN, RAMONA M TRUSTEE
1335 SW 197TH AVE 15265 SW 94TH AVE
ALOHA, OR 97006 TIGARD, OR 97224
PHONE: 503-528-6033 PHONE:
FAX: 866-284-0482
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 04/29/2019 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 04/29/2019 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 •the a..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 issuance, or if wo k s stpended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utilit. ,• .• Center. T ••- ru-s are set forth in OAR
952-001-0010 through OAR 952-001-0090. You m- •• -'•a c. - • - , •irect questions to OUNC by c- ing 503.23 987 or 1.8!,. 32. :44.
•
Issued By: Oe Si.nature:
.. �4.,, ---- X
OWNER INSTALLATION ONLYII
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 OFFI E I E Oy►.v
City of Tigard ,�.., 0� Received k � ,�
Date/B } Mrill.lriljniggin
13125 SW Hall Blvd.,Tigard,OR 972 Nan Review
: C Phone: 503.718.2439 p 219 Date/B : Related Permit#:
p
Email: TigardBuildingPermits@Tigard-or.go , Ready Date/By: Juris: ® See Page 2 for
R
1IGAD Q
Inspection Line: 503.639.4175 Internet: a w.tigar ivo-Q
( Notified/Method: Supplemental Information
TYPE OF WORK `�NG 9`V\S PLAN REVIEW
0 New construction jgAddition/alteration 12CCement 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.
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.
4E 117 -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
Job#: Job site address: ,5 f' i ,7�/t`/^ 41,,f 0 Addition of new motor load of system.
�� J t v 7 i t c 100HP or more. ❑ ` . " 2
City/State/ZIP: ❑Six or more residential units. occupancy.
ty / �- ` Ci�� ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each 1 Total I *
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'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
P6.146 / (with above sq.ft.) 75.00 2
( �"� Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
❑ PROPERTY OWNER ❑ 'TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less / 100.70 WO'74-' 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) 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
APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: �� 7 t'c.,), �7e e L above service or feeder fee,
each branch circuit 7.42 2
Contact name: 73i,e ju�4-„y^ B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: / 3� / S ,J i Cir branch circuit
City/State/ZIP: 14-!d/Lek L7 ', '7e1O 3 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(963 ) jZ y- &c,3.3 Each manufactured or modular 67.84 2
1 dwelling,service and/or feeder
Email: f,. ,e -7-
Email: Z i crit.e F`t''1�r C c avv-A. Reconnect only 67.84 2
Cl PRAf"I3R' - Pump or irrigation circle 67.84 2
Business name: 5 Z Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ 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.: / 9 7 cJ Electrical Lic.: C$j/ uprv.Lic.: J J Z J''.5 specifically listed(%2 hr min)
/ ELECTRICAL PERMIT-FEES
Suprv.Electrician signature,required: �; ` u - Subtotal: /00. 7‘-''Print name: y i j /1 s y 1 Date: 11/z,F11 q 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): / 0Authorized signature: 1,1-0------ TOTAL PERMIT FEE: 1 '7
K This permit application expires if a permit is not obtained within 180
Print name: '✓kelt LT , 54/kl Date: 9/2.q//9 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.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:
RESWENTM WORK ONLY: I
*
Fee for all residential systems combined: $75.00 _Description QtyEseh I Total
3r 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
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >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
n 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(%hr min)
,v RCIAL WORK ONLY, ELEt`TIll AL. PERMIT FEES
i:', It
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
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\ELCPermitApp_ELR_ERE.doc Rev 10/26/2017
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
15265 SW 94TH AVE, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Electrical ELC2019-00277
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Supplemental grounding installed.
Violation Summary:
Inspector Contractor