Permit IIII CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2020-00083
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/13/2020
T I(;h R I 9 Parcel: 2S 115AB01900
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY C
Project: Ace Hardware Subdivision: 1994-028 PARTITION PLAT Lot: 2
Project Description: Electrical for TI.
Contractor: ENERGY ELECTRIC LLC Owner: SN PROPERTIES PARTNERSHIP
27118 NE 10TH 1121 SW SALMON ST
RIDGEFIELD,WA 98642 PORTLAND, OR 97205
PHONE 360-727-3394
PHONE: 503-973-0205
FAX: 360-727-3397
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 02/25/2020 $100.70
Specifics: amps or less
1 ea Services or Feeders-201 to 02/25/2020 $133.56
Type of Use: COM 400 amps
Class of Work: ALT 1 ea Services or Feeders-601 to 02/25/2020 $301.04
1000 amps
Type of Const: 58 crt Branch Circuits w/Purchase 02/25/2020 $430.36
Occupancy Grp: Service or Feeder
1 ea Plan Review Electricial 02/25/2020 $241.42
1 ea 12%State Surcharge- 02/25/2020 $115.88
Electrical
Total $1,322.96
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 .proved 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: Oreg• =w r .-res you to folio the j1es adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OA• •: -oo .Q90. u ay obta' erules or direct questions to OUNC by calling 503.23 87 or 1.800.332.2344.
/ J pp CT r . /1/7 7
Issued By: ,. ;<-' / Permittee Signature: Gfi
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 603.639.4175 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.
V 1
Electrical Permit Application �'` ICD FOR Oi4:ICE USE ONLY
vG Received
UPI City of Tigard Date/By: 3//()Pt, / -r-----P Ern't#: r a- . l -(YXI63
• 13125 SW Hall Blvd.,Tigard,OR 97223 pp 'to2� Plan Review I
Phone: 503.718.2439 Fax: 503.598.19tr0 r_p O Date/B : `� / lated Permit#: r • ' I- - ' ' G.--
Inspection Line: 503.639.4175 IGABD Ready Date/By: • uric: gl See Page 2 for
TIGARD Internet: www.tigard-or.gov -t T
' OF iS)r-,t,' Notified/Me • ice`. 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):
CIService or feeder 400 amps or more 0 Building over three stories.
❑Demolition El 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 ❑✓ Commercial industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: I Job site address: 16200 SW Pacific Highway 1001IP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: Tigard, OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
tSupply voltagefor more than
Suite/bldg./apt.#: �,,,-%" Project name: Ace Hardware TI Tigard Towne Square 0 Hazardous locations. 0 uPP y
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 _ I
DESCRIPTION OF WORK Limited energy,residential
Renovation of entire space including services (with above sq.ft.) 75.00 z
Limited energy,multi-family 75.00 2
residential(with above sq.ft)
Renewable Energy 0 See Page 2 1 r
Q PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
CI Name: Harsch Investment Properties 200 amps or less 1 100.70 100.70 2
Address: 1121 SW Salmon St., Suite 500 201 amps to 400 amps 1 133.56 133.56 2
City/State/ZIP: Portland, OR 97205 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 1 301.04 301.04 2
Phone:( 503)973-0205 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
0 APPLICANT I ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Energy Electric LLC above service or feeder fee, 58 430.36
-
each branch circuit . 2
Contact name: James Rosenlund B.Fee for branch circuits without
7
42
Address: 27118 N E 10th Ave service or feeder fee,first
branch circuit 56.18 2
City/State/ZIP: Ridgefield, WA 98642 Each add'I branch circuit • 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360 )727-3394 Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: james@energyelec.net Reconnect only 67.84 2
Energy ElectricdoRAcToR Pump or irrigation circle 67.84 2
Business name:Energy Electric LLC Sign or outline lighting 67.84 2
Address: 27118 NE 10th Ave panel,, circuit(s)erao or extension, 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Ridgefield, WA 98642 Each additional inspection over allowable in any of the above
/ Additional inspection(I hr min) 66.25/hr
Phone:( 360) 727-3394 Fax:( ) V IL( - Investigation(I hr min) 90.00/hr
Email: james@energyelec.net 03 L� 7 fii2� 5 a G L4 Industrial plant(I s no) 78 18/hr
Inspections for which fee is 90.00/hr
CCB Lie.: 179089 ,�L�1•r S Electrical Lie.: ENERGEL937MS Suprv.Lie.: specifically listed(Vz hr min) •
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 965.66
Print name: James Rosenlund Date: 2/6/2020 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): _
Authorized signature: �� TOTAL PERMIT FEE:
,(/ ,` This permit application expires it a permit is not obtained within 180
Print name: �;rr,/; i'(/ r(cn ,0 ,(1 Date: --( y;_. days after it has been accepted as complete.
`W U • Number of inspections allowed per permit.
t:`Building\Permits\ELCUPermitAppgELRfERE.doe Rev 06/17/2015 440-4615T(I 1/05/COMAVEB