Permit Support Document CITY OF TIGARDA. ELECTRICAL PERMIT
11141 '_' r Permit#: ELC2019-00591
COMMUNITY DEVELOPMENT
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.243' it f. 5 Date Issued: 09/05/2019
IC \`�� Parcel: 2S103ACO2800
CP Jurisdiction: Tigard
Site address: 11075 SW ERROL ST
Project: PIERCE RESIDENCE ADDITION Subdivision: None Lot: None
Project Description: INSTALLING LIGHTS AND RECEPTACLES.9/23/2019:REPRINT to add(1)service feeder 200 amps or less and
(2)branch circuits.
Contractor: HILLSBORO ELECTRIC LLC Owner: PIERCE, DARREN F REVOCABLE LIVIN
21185 NW EVERGREEN PKWY#110 PIERCE,AMY J REVOCABLE LIVING TRUS
HILLSBORO, OR 97124 11075 SW ERROL ST
TIGARD, OR 97223
PHONE: 503-439-9666 PHONE:
FAX: 503-601-3680
FEES
Quantity Description Date Amount
1 ea Signal circuit or Limited 09/05/2019 $75.00
Specifics: Energy Panel
1 ea 12%State Surcharge- 09/05/2019 $9.00
Type of Use: SF Electrical
Class of Work: ADD 1 ea Services or Feeders-200 09/20/2019 $100.70
amps or less
Type of Const: 2 crt Branch Circuits w/Purchase 09/20/2019 $14.84
Occupancy Grp: Service or Feeder
0 ea 12%State Surcharge- 09/20/2019 $13.86
Electrical
Total $213.40
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 9 2-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
tSsuLQ-By: L' / _ Pel'rnTtttee Signature: k S
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Applicati0R E C E I V E® lei,{ ,e F I it l i •I e 1"
City of Tigard y CA rt\O A t \-1. Permit#:E--C---3 C�AC-C,� 1
114 -- . 13125 SW Hall Blvd.,Tigard,OR 97223 SEP 1 9 2019 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 gY Related Permit#:
I Inspection line: 503.639.4175 CITY OF TIGARD Ready Date/By: Asir RI See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Noti6et/Medved: ( bupplemerttat information
TYPE OF WORK
❑New construction PLAN REVIEW,
®Addition/alteration/replacement atien/replacement Preece check all slat apply(submit 2 sets ofpins w/items checked):
❑Demolition ❑Other: s. �� 0 Seuvice or$oder 400 or mon
\�Q amps ❑Building over three stories.
' r>17\\
� where the available fault current ['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 ❑Ace . Boding less to grotmd,or exceeds 14,000 0 Commercial-use agricultural
®Multi-family ❑Master builder ❑Other amps for all other installations. buildings.
JOB SITE INFORMATION AND LOCATION 0 Emergency system.Fire pump. ❑Installation
seise a tef 1Sd KVA or
.ger separately derived
Job#:9992 Job site address:11075 SW ERROL ST ['Addition of w motor load of system
100HP or more. 0"A""E',"1-2""1-3"
City/State/ZIP:TIGARD OREGON 97223 ❑Six or more residential omits. occupancy.
Suite/bldg./apt. ❑Health-caro facilities. 0 Recreational vehicle parks. '
&/apt.#: Project name:PIERCE RESIDENCE ❑Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal-
Cross street/directions to job site: FEB SCHEDULE
nesestotsoa I Coy. 1 read. I Tont I •
New residential single-or multi-family dwelling unit.
Subdivision: ( Lot#: Includes attached ganga.
Tax map/parcel#: 1,000 sq.ft.or less 16854 4
Ea.add'1500 aq.ft.or potion 33..92 1
DESCRIPTION OF WORK Limited energy,residential
INSTALLING LIGHTS AND RECEPTACLES (with above� ) 75'00 2sq.ft.)
Limited energy,mufti-family 75.00 2
residential(with above sq.R)
❑ PROPERTY OWNER ❑ TENANT Renewable Energy 0 See Page 2
Services or feeders installation alteration,and/or relocation
Name:PIERCE,DARREN F REVOCABLE LIVIN 200 amps or less ! 100.70 j( '1() 2
Address:11075 SW ERROL ST 201 amps to 400 amps 133.56 2
City/State/ZIP:TIGARD,OREGON 97223 401 amps to 600 amps 200'34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or oohs 552.26 2
Email: Temporary services or feeders inetalladon,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or leas i 59.36 1 I 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 Owner signature: Date: 401 amps to 599 amps 168.54 I22
1:1 APPLICANT 0 CONTACT PERSON
Branch eareaits—new,alteration,or extension, panel
A Fee for branch circuits with
Business name: above service or feeder fee, 7.42
each branch circuit '�Li.1 2
Contact name:
a Fee for branch circuits without
Address: service or feeder fee,first
branch56.18 2
circuit
City/State/ZIP: Each add'l branch circuit 7A2 2 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular
Eitia.1' dwelling,service and/or feeder 67,84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
I
Business name:HILLSBORO ELECTRIC Sign or outline lighting 67.84 2 $
.1128
pane],alteration,or extension D sei Paged 2
City/State/ZIP:HILLSBORO OREGON 97124 Each addetienal inapextion over allowable in any of the above
Additional inspection(1 hr min) I 66.25/hr
Phone:(503)439-9666 Fax:( ) Investigation(1 hr min) 90.00/hr $
Email:PMAST@HILLSBOROELECTRIC.COM Industrial plant(1 hr rein) 78.18/hr
Inspections for which no fee is 90.001 hr
CCB Lie.: 134481 Electrical Lie.; 34-499C Suprv.Lie.: 4941S specifically listed(%hr min)
ELECTRICAL PERMIT FEES
Suprv,Electrician signature,required: Subtotal:
Print name: JOEY VITACCO ' Date: 09/19/19 0 Plan Review Required(25%ofpenmit fee):
State surcharge(12%of permit foe): 7 3.140{p
Authorized signature: f s ' , ,%/ TOTAL PERMIT FEE: ,�(�
This permit application expires ifs permit is not obtained within tau
Print name: JOEY VI ACCO Date: 09/19/19 days after it has been accepted as complete. 1
Number of inspections allowed per permit s
1:1Building;PaYtiftealC PermitApp EU ERE.doc Rev 06/17/2015 440-46t5T(tl/05/COMNVES
a
t'
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
11�u,x� .� . .;.,l .wxu$'. d�'x su pis o
Fee for all residential systems combined: $75.00 Description Qty. ��Each Total I♦
Renewable electrical energy systems:
Check Type of Work Involved: s 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
❑ 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
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(V2 hr min
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): I„
* 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
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