Permit 1:1114 CITY OF TIGARD ELECTRICAL PERMIT
8 COMMUNITY DEVELOPMENT Permit#: ELC2022-00758
T I t;A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/16/2022
Parcel: 1 S136DC04600
Jurisdiction: Tigard
Site address: 7255 SW DARTMOUTH ST
Project: Planet Fitness Subdivision: 1995-013 PARTITION PLAT
Lot: 3
Project Description: Running wire for(7)new thermostats.
Contractor: VIKING HEATING&SHEETMETAL LLC Owner: COMMERCIAL NET LEASE REALTY, INC
15779 SE JANSIK CT 450 S ORANGE AVE, STE 900
DAMASCUS, OR 97089 ORLANDO, FL 32801
PHONE: 503-679-8096 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea 12%State Surcharge- 11/16/2022 $9.00
Specifics:
Electrical
1 ea Signal circuit or Limited 11/16/2022 $75.00
Type of Use: COM Energy Panel
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $84.00
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 issu- ce. or if work/ is suspended for more the
180 days. ATTENTION. Oregon law requires • . follow the rules adopted by the Oregon Utility No• cati ter . ho kules �tJ set set forth in OAR
952-001-0010 throua R 5 -00 -00 D a coovoi the rules or direct cuestions to OUNC by calling 503.-• 7 or 1.80Mb 4 :
Issued By: i /+�� /r Permittee Signature:
WNER 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 t,\I,,
- DatdB City of Tigard Received
DateB . II I • �e-1
� Permit#: L C....cc_ -007
• 13125 SW Hall Blvd.,Tigard,OR 97223 �UG4
Phone: 503.718.2439 Fax: 503.598.1960 Plan ElR : Related Permit#:
7'I Ci A RP Inspection Line: 503.639.4175 Ready Date/By: Arms: 65 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
0 New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/itean checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other:
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling a Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
El Mulct-famil amps for all other installations. buildings.
Y ❑Master builder ❑Other: ❑Fi1e
JOB SITE INFORMATION AND LOCATION ❑Emergency system. 0 Installation rpa ato l Sd 1CVA or
gar separately derived
Job#: Job site address: L�'S ��1� ❑Addition of new motor load of system.
y �1.� ,f("V�'�.' 1o0HP or more. ❑"A" "E""1-2"`7-3"
City/State/ZIP: 1 L�r'a/ 0 ❑Six or more residential units. occupancy.
<J il a^^ ❑Health-care facilities. ['Recreational vehicle parks.
l
Suite/bldg./apt.#: Project name: i .V Irk v•tlC nkis ❑Hazardous locations. ['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 Qly, I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: 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 1
DESCRIPTION OF WORK Limited energy,residential
�`(q�n ��Q (with above sq.ft.) 75.00 2
��` t✓JkY "p '�1�� ` e Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
❑ PROPERTY OWNER ID TENANT
Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
City/State/ZIP: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation alteration,and/or
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
'gt"APPLICANT Dr CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: V t ' `C?VC Y +fJ"'^ A { M , kl, ekcI t . above service or feeder fee,
each branch circuit 7.42 2
Contact name: �' '�Q;
f'� B.Fee for branch circuits without
Address: service or feeder fee,first
�c ft, S k v v `5 i_ branch circuit 56.18 2
City/State/ZIP: y f k�\' () acts C - 7-` t..t Each add'l branch circuit 7.42 2
l V / Miscellaneous(service or feeder not Included)
Phone:( ICJ3) (4, _ tcyt CO Fax::( ) Each manufactured or modular
67.84 2
dwelling,tt service and/or feeder
Email:
CAA. 0_,U N ,.c rjk.S .tia.,.((vv. Reconnect only 67.84 2
it)NTRACTOR Pump or irrigation circle 67.84 2
Business name: (I�nv: .- ` I. _ _ t � Sign or outline lighting 67.84 2
SiAddress: i I C eUSS rah- 3CC ) 4�f panneell,,alterati nor limited-energy �Page2 I 2
l ] on or extension.
City/State/ZIP: Each additional inspection over allowable In any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(Coy �11 - T c, Fax:( L) Investigation(1 hr min) 90.00/hr
Email: a, fJ `i, ^ .‘vv ,„04-vv • tees,-
Industrial plant(I hrmin) 76.18 hr '
Inspections for which no fee is
CCB Lic.: Electrical Lic.: OLF p � �
q2�L Suprv.Lic.: specifically listed(F<hrrein) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required
Subtotal:
Print name: --1...alk_ &1t A& Date: [l/ , ( _ 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature gn TOTAL PERMIT FEE: !�J
n This permit application expires if•permit Isnot obtained within PM
Print name: !�t`,0 (�`�.7 PJI,e/� Date: l`/ days after it has been accepted as complete.
* Number of inspections allowed per permit.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Deeaiptioa I Qty. I Each I Total I •
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
❑ A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >I00 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 66.25f hr I
charged at an hourly(I hr min)
Inspections for which no fee is 90.00!hr
specifically listed(Vs 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) Namner of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ C• lock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
Q'I-iVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ N• urse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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