Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2019-00842
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/04/2019
Parcel: 1 S134AC08000
Jurisdiction: Tigard
Site address: 11022 SW GENEVA ST
Project: Smith Subdivision: JEFFREY ESTATES Lot: 17
Project Description: (3)branch circuits for lighting,exhaust fan,and floor heat in upstairs bathroom.
Contractor: ABS ELECTRIC LLC Owner: SMITH, JASON C& LINDSEY J
752 DIVISION ST 11022 SW GENEVA ST
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503-888-7676 PHONE:
FAX: 503-257-6168
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 12/04/2019 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/04/2019 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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
nn3 Center. Those rules are seat?forth. n OAR
952-001-0010 through OAR 952-001-0090. You may obtain a opy of the-rrtles or direct questions to OUNC by calltn`g 503.2�z.1987 or 1.8 .332.2 4. /7401
Issued By: !r �� 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 FOR OFFICE USE Oyl.1
City of Tigard Received
114 " 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review I 9
O 'OMAN Permit#: _ - i
sw Phone: 503.718.2439 Fax: 503.598.
D /B : Related Permit#: / /AiA_ 4.
TIGARDInspection Line: 503.639.4175 QS ....\:\l ''''
Ready Date/By: El See Page 2 for
® Internet: www.tigard-or.gov ! ��CC 41- Notified/Method: EMI
Supplemental Information
TYPE OF WOI - �`Gg\ �a " PLAN REVIEW
❑New construction .Addition/alteratio .i l mtN\S\ Please check all that apply(submit 2 sets of plans w/items checked):
�� \NG 0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other:
TR\-1 where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONS UCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
Er 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑Multi-family ❑Master builder ❑Other: ampsireform all other installations. Installation
buildings.
0 Fire pump. 0 Insal of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
ij
Job#: Job site address: t 1®2 2. s((J 6E/VEV f1 S i - 100HP or more. ❑"A"> E","l-z",°`1-3",
City/State/ZIP: '\ ,/7'Z ❑Six or more residential units. occupancy.
ty �� ✓ I V �� 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:!o !yowl a, , q/y f v qth-
����"" 1�/ �//� FEE SCHEDULE
TL • wit SW ' &�V L4q.. ST� Description I Qtr. I Each I 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,_ �/,, �q, , residential 75.00 2
j et6t/14 d") VAC 6 tJ 'r C1 vm ' 1" -C . (with above sq.ft.)
Limited energy,multi-family
'mil%a `t+ -t "
04 i ��/ ( 1 residential(with above sq.ft.) 75.00 2
6 V "' Renewable Energy 0 See Page 2
PROPERTI OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: k7A/ S M1 1 200 amps or less 100.70 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
El APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first j
Address: branch circuit / 56.18 �o l 2
City/State/ZIP: Each add'l branch circuit 1_ 7.42 /t 'Pt 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: -3S �'7 l C GC C Sign or outline lighting 67.84 2
-7 � Signal circuit(s)or limited-energy
Address:
/5-2 Diu I, oO 1�/ 5"`r . panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP:v E69nl C/ry x cf 7� C Each additional inspection over allowable in any of the above
( ` Additional inspection(1 hr min) 66.25/hr
Phone:(993 we.. 76 76 Fax:( ) Investigation(1 hr min) 90.00/hr
e-C e r Industrial plant(1 hr min) 78.18/hr
Email. Inspections for which no fee is
specifically listed '/z hr min) 90.00/hr
CCB Lic.:150) 74 Electrical Lic: ' k Suprv.Lic.: 3 p Pe y (
,i !/ ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: , t
/'} ,� }1 Subtotal: 7 1.
Print name: (,:y /� �. ( Date: ❑Plan Review Required(25%of permit fee):
v t {T� State surcharge(12%of permit fee): 1--
Authorized signature: `.. TOTAL PERMIT FEE: 7ej
i 1 A This permit application expires if a permit is not obtained within 1810
Print name:`�'�VVI ^ • � )d /t Date: days after it has been accepted as complete.
Yl l v 1 ®/(� �/ * Number of inspections allowed per permit.
I:\Building\Permits\ELC PermrtApp ELRERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB