Permit (4) liCITY OF TIGARD ELECTRICAL PERMIT
I. COMMUNITY DEVELOPMENT Permit#: ELC2019-00652
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/01/2019
T[GAR.�) g Parcel: 1S135CD02401
Jurisdiction: Tigard
Site address: 11945 SW 95TH AVE
Project: Del Rey Properites Subdivision::HERS ADDITION TO GREENBURG HE Lot: 8
Project Description: Replacing(1)200 amp services panel,and(2)branch circuits.
Contractor: SANDY ELECTRIC INC Owner: DEL REY PROPERTIES LLC
12130 SE VIRGINIA CT 1831 NE 9TH PL
SANDY, OR 97055 HILLSBORO, OR 97124
PHONE: 503-961-5140
PHONE: 503-680-1136
FAX: 503-668-8431
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 10/01/2019 $100.70
Specifics: amps or less
2 crt Branch Circuits w/Purchase 10/01/2019 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 10/01/2019 $13.86
Electrical
Type of Const: 90 Investigation Fee 10/01/2019 $90.00
Occupancy Grp: 11 Investigation Electrical 12% 10/01/2019 $10.80
State Surcharge
Total $230.20
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 requires you to folio the rules,•o•te __ -_ - " - Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 95, •01-0090. -. may obtai „cop /1 es or direct questions to OUNC by calling 503.232.1987 or 1.800. 2.2344.
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Issued By: .,- e art ,/'! 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 10R OFFICE 1 SE 0v1.1
City of Tigard Da� A IIIA"Will _ 3
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 Date/B :
Inspection Line: 503.639.4175 Ready Date/By: Sufis: 0 See Page 2 for
T I G A R D Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ®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 0 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 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agicultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: ['Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: j�45 s tw 1 cks- U c..- 0 100H Addition of new motor load of system.
100HP or more. ❑system.
City/State/ZIP:,r--. 0 Six or more residential units. occupancy.
l,..?-t' r 0 Health-care facilities. 0 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 j Total 1
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.midi 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
-
W (with above sq.ft.) 75.00 2
�G we-J l\ C ,e:-
.AvaLt woks_ Am` t 1l V Limited energy,multi-family
) cC..- 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: 200 amps or less I 100.70 k DCI;Tb 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:( ) Fax:( ) 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: S }c�\ 1,,.t above service or feeder fee, )t...0
--s
each branch circuit 742Lk 2
Contact name: �t.W ,a„,,,t
B.Fee for branch circuits without
Address: c ��tt t� (�r� service or feeder fee,first 56.18 2
(
. �Q ,E, `d�t Y�o., l , 1 i� branch circuit
City/State/ZIP: - Each add'I branch circuit 7.42 2
'ES"
Miscellaneous(service or feeder not included)
Phone:(SOI) ( izi ,5)10 Fax::( ) Each manufactured or modular 67.84 2
Email: S 4 Ly �`Gt'l � VBG e 1,\x` dwelling,service and/or feeder
LI �.. C,iD 1�` Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: . ...V Sign or outline lighting 67.84 2
*�^ ^..11 Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: `LA L 0 '� ,G, v(i 1 (,,. panel,alteration,or extension.
City/State/ZIP: I �t. �"� Each additional inspection over allowable in any of the above
ty `1 7 V uJ Additional inspection(1 hr min) 66.25/hr
Phone:(S�jD) C162] v'(40 Fax:( ) Investigation(1 hr min) 90.00/hr
S Cl t L k.ve_. _4.; W., , , MS„ / Industrial plant(1 hr min) 78.18/hr
Email:
.,J CO O �(�///2_2_ Inspections for which no fee is
90.00/
hr
CCB Lic.: ('1 1. to fc Electrical Lic.: ( .jJ a Suprv.Lic.: SSS S-.S specifically listed(V2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: e t,r Subtotal: it) I , 7 O
Print name *.,,` Ott Date: I ZS 11 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): )Z,
TOTAL PERMIT FEE: ) 13 90
Authorized signature: t
This permit application expires if a permit is not obtained within 180
Print name: t4.-_,...--..a........--_ Date:50- / days after it has been accepted as complete.
' Number of inspections allowed per permit.
I:\Building\Permits\ELC PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COMIWEB