Permit 71 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT
Permit#: ELC2022-00271
Date Issued: 4/28/2022
TEGAR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S1 34BC00600
Jurisdiction: Tigard
Site address: 12390 SW SCHOLLS FERRY RD
Project: Kiss Car Wash Subdivision: 1993-057 PARTITION PLAT
Lot: 2
Project Description: (1)200 amp service for cell tower decommission and removal.
Contractor: GREEN POWER ELECTRICAL CONTRACTORS INC Owner: THOMPSON, DENNIS C
PO BOX 836 9295 SW ELECTRIC ST
AMITY, OR 97101 TIGARD, OR 97223
PHONE: 971-259-1051 PHONE:
FAX: 503-835-2702
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 04/28/2022 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 04/28/2022 $12.08
Type of Use: COM Electrical
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $112.78
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. hose rules are set forth in OAR
952-001-0010 through O 52-001-0090. You may ghfai of th • ct Questions to OUNC by calling 5 232.�1987 or 1. O. 32.2344.
Issued B (``//..✓�/1/,_ r �/"
Y: ermittee Signature: 11
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.
- Electrical Permit Application FOR OFFICE USE ONLN'
City {'T1 and Received
of g DateB /mri �[i // r// •/t
Ma
-'� 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
li Phone: 503.718.2439 Fax: 503.598.1 ri `,,, r ,t Related Permit#:
(, ,� ( .� Date/B
Inspection Line: 503.639.4175 ! i ,r 4_,4 "Ready Date/By: Mill l i See Page 2 for
TIGARD Internet: www.tigard-or.gov Notified/Method: Supplemental information
>,., TYPE OF WORK ` a AV 4, PLAN REVIEW
❑New construction ❑Addition/alteration/repleacement Please check all that apply(submit 2 sets of plans w/items checked):
�-� ❑Service or feeder 400 amps or more ❑Building over three stories.
E/Demolition 0 Other: t,i i;4 I ;r,' !;.,` ''() ; 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 [Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: 0 Fire pump. ❑Installation of 150 KVA or
:JOB SITE INFORMATION;AND;IiOCATION ❑Emergency system. larger separately derived
12390 SW Scholls
Job#: Job site address: ❑Addition of new motor load of system.
Ferry 100HP or more. ❑"A","E","I-2","1-3",
City/State/ZIP:Tigard, Oregon 97223 ❑Six or more residential units. occupancy.
g g ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: erry f✓l!Sf �ir��}t' 0 Hazardous locations. 0 600 Supply
olts nominal more than
i re ❑Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Scholls Ferry SW North Dakota ST and nescripti°" I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: includes attached garage.
1,000 sq.ft.or less 1
Tax map/parcel#:1 S134BC-00600
Ea.add'I 500 sq.ft.or portion . 4
33.92 1
'',:}2', DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Decommission and Removal of tower, all tower equpment, cabinet:, Limited energy,mttlti-family
residential(with above sq.ft.) 75.00 2
and all ground eqiupment • Renewable Energy 0 See Page 2
® PROPERTY- OWNER j , • ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name:Dennis C Thompson do Kiss Car Wash 200 amps or less I 100.70 /ZV,)t; 2
Address:9295 SW Electric Street 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard, Oregan 601 amps to 1,000 amps 301.04 2
Phone:( 508-781-0124 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:skidennis@aol.corn 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
i„
CONTACT PERSON Branch circui new,alteration,or extension,per panel
A.Fee for branch ts—circuits with
Business name:Global Signal Acquisitions Ill LLC above service or feeder fee, 7.42 2
each branch circuit
Contact name:Sally Natalino B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address:12390 SW Scholls Ferry branch circuit
City/State/ZIP:Tigard, Oregon 97223 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 602845-1704 Fax: :P24 )416-6972 Each manufactured or modular 67.84 2
Email: .na salt talino crowncastle.com dwelling,service and or feeder
y @ Reconnect only 67.84 2
CONTRACTOR
Pump or irrigation circle 67.84 2
Business name:GPEC Inc Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: pp Box 836 panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
h Amity, OR 97101 Additional inspection(1 hr min) 66.25/hr
Phone:(971 )259-1051 Fax:( 503)835-2702 Investigation(1 hr min) 90.00/hr
Email: kat pecelectric.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB c.: 1 s 1b71`33_ji 7 lectrical Lic.: C737 741113 Suprv.Lic.: 55313 specifically listed('/hr min) 90.00/hr
ELECTRICAL FEES
uprv.Electrician signature,required: ► `_ Subtotal: /00, 7u
Print name: Karter Roberts Date: 4/27/2022 0 Plan Review Required(25%of permit fee):
( L.
/�^ ^ State surcharge(12%of permit fee): �t�. GfAuthorized signature: /� J\ TOTAL PERMIT FEE: , !1 1,'f This permit application expires if a permit is not obt9inled wwithin IUSO
Print name: r'I S A i i t,Grl el_-‹ Date: oy4 je,/a� 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 4 615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: -PEE SCHEDULE
Description I Qty. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 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:
1 ❑ Burglar Alarm g 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 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(Y�hr min) ,
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
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: Data Telecommunication Removal
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015