Permit CITY OF TIGARD ELECTRICAL PERMIT
$ ie COMMUNITY DEVELOPMENT Permit#: ELC2021-00494
Date Issued: 9/9/2021
T I G AR 0 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111 BB01500
Jurisdiction: Tigard
Site address: 10362 SW MCDONALD ST
Project: Tigard Recovery Center Subdivision: TIGARDVILLE HEIGHTS Lot: 1
Project Description: (2)branch circuits for A/C and furnace.
Contractor: OWNER Owner: WASHINGTON COUNTY
169 N FIRST AVE, MS 42
HILLSBORO, OR 97124
•
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 09/09/2021 $63.60
Specifics:
Service or Feeder
1 ea 12%State Surcharge- 09/09/2021 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 throuKOAR 952- G.1-0090. You may obtain a coov of the rules or direct auestions to OUNC by callina 503.232.1987 or 1.800.332.2344.
Issued By: ' ��,'/w( dii _,/' Permittee Signature: /s1% `''C')/111---7(1 `/ 77Cr r1.,'
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'N 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.
"As"- , _ ^Electrical Permit Applicati ECEIVED FOR OFFICE USE ONLY -
City Of Tigard Received I at
2` Jia Pcrmil i�
• 13125 SW Hall Blvd.,Tigard,OR 97223 SEP 1 2021,
Plan Review
/AK4 ��. G/���� Y
IllII
gPlan Review
Phone: 503.718.2439 Fax: 503.598.1960 oate,By. Related Permit#:
I I�,A Ii O Inspection Line: 503.639.4175 CITY OF TIGARL) Ready oateBy: Juris:` ®See Page 2 for
Internet: www_tigard-ar.gov Vutified/Mcthod: _I(r1 Supplemental Information
TYPE OF rlJDING DIVISION! PLAN REVIEW
❑New construction Ig,Additionialteration/replacement Please check all that apply(submit 2 sets of plansw/hems checked):
El Demolition ❑Other: 0 Service or feeder 400 amps or inure 0 Building over three stories.
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 0 Accessory building less to ground,or exceeds14.000 ❑Commercial-aseagricultural
amps Ibr all other installations. buildings.
❑Multi-family ❑Master builder ��rrOther:
p�, ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ['Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address: 0362, SW/l4.11 oi,j J Sf-: 100HP or more. ❑"A","F.",`I-2","I-3",
City/State/ZIP: psyur" 2
�7 ❑Six or more residential units. occupancy.
"' / 2-'f ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or
Cross street/directions t0 job site: none 600 volts nominal.
TI 6A J2 l� (tE"CP1 V 7Z-- FEE scltEosnE
Description I qrs. I Each 1 Total 1
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'I 500 sq.It.or portion 33.92 1
DESCRIPTION OF WORK
/ Limited energy,residential
'NI S. + f-e �� P w ¢ (with above sq.ft.) 75.00 2
�= "PM— /Tf Limited energy,multi-family 75.00 2
r Yip t. �,I,0. 1.- residential(with above sq.ft.)
el AWN I • 0 TENANT Renewable Energy 0 See Page 2
PROPERTY OWNERServices or feeders installation,alteration,and/or relocation
Name: Was4x.4vs A,— C j ..` /..t�S 200 amps ur less 100.70 2
Address: ,G 9 /�/r. /£f �l _ ,4 S—e./[sT., //� 201 amps to 400 amps 133.56 2
City/State/ZIP: i t �p�0G 7 .s f1 401 amps to 600 amps 200.34 2
).4 eli,J'2-Y 601 amps to 1,000 amps 301.04 2
Phone:Irer3 ) t.t-J7/S 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,rem,or exchange, rding to ORS 447,449,670,an 701. 201 amps to 400 amps 125.08 2
Owner signature� H>G� Date: 2 401 amps to 599 amps 168.54 2
APPLICANT 1 CONTACT PERSON Branch circuits-sex,alteration,or extension,per panel
r A.Fee for branch circuits with
Business name: gj /- ���1 ['_ t/f - ref, above service or feeder fee. 742 2
1M 7, IR..a1 TY each branch circuit
Contact name: JA—r� ��/�,4e B.Fee for branch circuits without
/• service or feeder fee,first 56.18 J!� 1 2
Address:/CQ A). /A�' /�.__ -ta(+�' branch circuit a 3 y
City/State/ZIP:yh//d,,,t,, p,r jJ2[J Each add'I branch circuit / 7.42 7,ff i 2
1 Miscellaneous(service or feeder not included)
L Phone:15b3)d'9-/a'7 Fax::( ) Each manufactured or modular
67.84
ec .walla/ pis.orluj dwelling,terviceand/orfeeder 2
Email:~k a le
V _ Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(l hr min) 78.18.rhr
Inspections fur which no tee is 90.00-hr
CCB Lie.: Electrical Lie.: Suprv.Lic.:40579S mpg ecitically listed('/hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
40
Print name: ,4 ��! �V24/mil ID Plan Review Required 125%n of permit fee): L 3.
/v_ State surcharge(12%of permit fee): ). ts3 , /
Authorized signature: e ,/ TOTAL PERMIT FEE; 7 1. 22.3 V
I` A-/ This permit application expires it a permit is not obtained wit►in 180
Print name: �'7"% , Date: / days after It has been accepted as complete.
* Number of inspechuns allowed per permit.
1..4haldinglPermirsiEIC PernitApp ELR_ERE.doc Rev 06/1 5 4.41-46157f11/05 CON/WED
M 4 i 4J P 1 pYlEczoz.(—oO4`I?
RECEIVED
Property Owner Statement SEP ' 2°3,21:
Regarding Construction Responsibilities UITYOFTIGARD
Oregon Law requires residential construction permit applicants who are not licensed with theVI�DING DIVISION
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building,electrical, mechanical,and plumbing permits.
Licensed architect and engineer applicants,exempt from licensing under ORS 701.010(7);need not
submit this statement.This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
-7<„, I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
- Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
11a A.
Print Name of Permit Applicant
,9/4/7._D
ignature of Permit Appli Date
Permit#: Et-c.icy --f10 y
Address: 10 36 Z. rW G flPi'Fr-L ��
Ili q 1
r .%"
Issued by: Date: ru -
This Copy for Permit Offices
� ' • Information Notice to Owners About
F-
Construction Responsibilities
\rEtr (ORS 701.325 (3))
Homeowners acting as their own general contractors to construct a new home
or make a substantial improvement to an existing structure,can prevent many problems
by being aware of the following responsibilities:
• Homeowners who use labor provided by workers not licensed by the Construction Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
• Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages
at the time employees are paid. You will be liable for the tax payments even if you don't actually
withhold the tax from your employees. For more information, call the Department of Revenue at
503-378-4988.
• Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information, call the Oregon Employment
Department at 503-947-1488.
• Oregon's Business Identification Number(BIN): is a combined number for both Oregon
Withholding and Unemployment Insurance Tax. To file for a BIN, go online to the Oregon Business
Registry. For questions, call 503-945-8091.
• Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain
Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs
if one of your workers is injured on the job. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 800-452-0288.
• Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from
employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax.
For a Federal EIN number, go online to www.irs.gov.
Other Responsibilities of Homeowners:
• Code Compliance:As the permit holder for a construction project, the homeowner is responsible
for notifying building officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
• Property Damage and Liability Insurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensation Insurance.
• Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough-in and finish trades.
CONSTRUCTION CONTRACTORS BOARD
PO Box 14140,Salem,OR 97309-5052
Telephone:503-378-4621 —Fax:503-373-2007
Website Address:www oreoon gov/ccb
f/property_owner adopted 9-2016 This Copy for Permit
Dianna Ornelas
From: #Building Permit Technicians
Sent: Monday, September 6, 2021 10:17 AM
To: mark_epling@co.washington.or.us
Subject: ELC2021-00494 - 10362 SW McDonald St -Tigard Recovery Center
Attachments: ELC2021-00494.pdf
Hello Mark,
This permit is ready to issue and the balance due is$71.23 (see attached invoice).
The fees can be paid online at https://aca-prod.accela.com/TIGARD/Welcome.aspx by searching for the permit record
number ELC2021-00494 under the Building tab. Payment can be made by'card' for a 3%service fee or select the 'check'
payment option and there is no service fee.
Please email the permit technicians at TigardBuildingPermitsCc@tigard-or.gov once the fees are paid so that we can issue
the permit and email a copy.
Thank you.
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
1