Permit CITY OF TIGARD ELECTRICAL PERMIT
tIII s in COMMUNITY DEVELOPMENT Permit#: ELC2022-00445
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/24/2022
Parcel: 1S126CC00200
Jurisdiction: Tigard
Site address: 10069 SW CASCADE AVE
Project: Tesla Subdivision: None Lot: None
Project Description: Electrical for service area shell building.
Contractor: JC ELECTRIC INC Owner: 10065 SWC LLC
8117 NE 13TH AVE BY ALSTON &BIRD LLP
VANCOUVER, WA 98665 BANK OF AMERICA PLAZA
101 SOUTH TRYON ST STE 4000
CHARLOTTE, NC 28280
PHONE: 360-887-7889 PHONE:
FAX: 360-887-5584
FEES
Quantity Description Date Amount
1 ea Services or Feeders-201 to 09/26/2022 $133.56
Specifics: 400 amps
47 crt Branch Circuits w/Purchase 09/26/2022 $348.74
Type of Use: COM
Service or Feeder
Class of Work: NEW 2 ea Sign or Outline Lighting 09/26/2022 $135.68
Type of Const: 1 ea Plan Review Electricial 09/26/2022 $154.50
Occupancy Grp: 1 ea 12%State Surcharge- 09/26/2022 $74.16
Electrical
Total $846.64
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 throuah OAR 952-001-0090. You may obtain a c H rules or direct Questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 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'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 s J ,..' �3; c- Received FOR OFFICE USE ONLY
Mil
City of Tigard a mit x:
Date/By: (�f
13125 SW Hall Blvd.,Tigard,OR 97223 �( I -�r a (f
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: 7 Related Permit p:
TIGARD Inspection Line: 503.639.4175 Read Date/By: / Is: ® See Page 2 for
x Internet: www.tigard-or.gov N ,d/Metho ( •Tr�y Supplemental Information
,,:,... TYPE OF WORK PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please eck all that apply(submit 2 sets of plans w/items checked):
ervice or feeder 400 amps or more ❑Building over three stories.
0 Demolition ❑Other where the available fault current 0 Marinas and boatyards_
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑Floating buildings.
El 1-and 2-family dwelling x❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other:
CI Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND.LOCATION 0 Emergency system. larger separately derived
['Addition of new motor load of system.
Job#: Job site address: 10069 SW Cascade Ave. IOOHP or more. ❑`A^, 'E,'1-r', l-3',
City/State/ZIP: Tigard, OR 97223 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Testa za❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: -- M,
• FEE SCHEDULE
Description I Q v. I Each I Total I '..
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: 1 S 1 26CC 002200 Ea.add'l 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK ` energy,residential
.. _ i'' _-,-, Limited 75.00 2
TENANT INTERIOR ALTERATION TO SALES SERVICE AREA TO INCLUDE (with above sq.ft.)
Limited energy,multi-family 75.00 2
NEW WALLS, FINISHES, FIXTURES,AND PAINT residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER f TENANT Services or feeders installation,alteration,and/or relocation
Name: Tesla 200 amps or less 100.70 2
Address 201 amps to 400 amps 1 133.56 133.56 2
901 Page Ave QQ 401 amps to 600 amps 200.34 2
City/State/ZIP: Fremont. CA 9453c{ 601 amps to 1,000 amps 301.04 2
Phone:( ) I 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 I
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
CI APPLICANT '® CONTACT PERSON Branch circuits—new,alteration,or extension, .er panel
A.Fee for branch circuits with
Business name: ArcVislon, Inc above service or feeder fee, 47 742 348.74 2
each branch circuit
Contact name:Joanie Godsey B.Fee for branch circuits without
Address: 1950 Craig Road, Suite 300 seMhcircu or ederfee,first 56.18 2
branch circuit
City/State/stt Louis MO 63146 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(336 )830-1111 Fax: :( ) Each manufactured or modular
dwelling service and/or feeder 67'84 2
Email: )godSey@arcv.Com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: TBD Sign or outline lighting 2 67.84 135.68 2
Signal circuit(s)or limited-energy —`
f
Address: panel,alteration,or extension. i '- ee Page 2 1`S�'2
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(I hr min) 78.18/hr
Inspections for which no fee is 90 00t hr
CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed('A hr min)
ELECTRICAL PERMIT.FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
iJoane 2gaulrJaogan4
me GJoen=Gusley
This permit application expires if a permit is not obtained within ISO
Print name: o=ARCVI5lON. Date: 06/13/22 days after it has been accepted as complete.
Godsey emal=Jaodsey@arcv nom
uma:m2t0E.,,ue.e.:m-uauu * Number of inspections allowed per permit.
I:\Building\Permes`5ELC PemWApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
_r'
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEESCHEDULE
Description Qm Each I Total
Fee for all residential systems COmbined: $75.OU Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n Burglar Alarm 25.01 to 50 kva 301.04 2
n Garage Door Opener* soot to 100 kva 552.26 2
>100 kva(fee in accordance 552.26 2
nwith OAR 918-309-0040)
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:
n Other: Each additional inspection is 66.25/hr
charged at an hourly(I hr min)
Inspections for which no fee is
specifically listed('/hr min) 90.001 hr
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal
(sorer on Page 1):
F.umber of inspections allowed
per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑X Data Telecommunication Installation
n Fire Alarm Installation
❑X HVAC
n Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building'PennhsELC_PermdApp ELR_ERE.doc Rev 06/17/2015
Electrical Permit Application B-MAILED FOR OFFICE USE ONLY
City of Tigard Received
,� g Date/By: Permit i4: ��.. ,n -00a, ' `
• 13125 SW Hall Blvd.,Tigard,OR 97223 N/f 2672 Plan Review / '(�
. Phone: 503.718.2439 Fax: 503.598.1960 JUN ""�
Date/By: Related Permit#;
Inspection Line: 503.639.4175 Ready Date/By: turfs: 10 See Page 2 for
T I G A 12 D. Internet: www.tigard-or.gov Notified/Method:
Supplemental Information
TYPE OF WORK PLAN REVIEW
0 New construction igl Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
I,$
❑Demolition El Other: Service or feeder 400 amps or more 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 ❑Floating buildings.
❑ I-and 2-family dwelling 0-Commercial/industrial 0 Accessory building ess to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ amps for all other installations. buildings.
❑Multi-family D Master builder Other:
El Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address: 0 Addition of new motor load of system.
'v 11G r i(A) /w�. 100HP or more. ❑"A" "E" "l 2" "1-3"
City/State/ZIP: D,/CCwl 1 7 ZZ? El Six or more residential units. occupancy.
�J' / vvie t J ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 7'sI4.,SLot. .i.bo 1. 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more 600 volts nominal.
Cross streel/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I w
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
G 12/ /G £2� 1,000 sq.ft.or less 168.54 4
J
Tax map/parcel#: 1 b C
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
1looAA / "� (with above sq.ft.) 75.00 2
,Serv;(ti Ac t ' bl"'(j ,)(is(� " 1�e�/ c(-5'�L Limited energy,`� r,_ _ multi-family 75.00 2
WO Lewt a ?i J(tra,4- IF.&Ap 2)22-Q0 Iq S-- residential(with above sq.ft.)
❑ PROPERTY OWNER El TENANT
J Renewable Energy ID See Page 2
Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps ' 133.56 )33,5 2
City/State/ZIP: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2 I
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 I
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 - El CONTACT PERSON •
Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 3 7.42 Z 2, 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
Email: - dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: JG IL 1 e ,.`y t(. , feu... Sign or outline lighting 67.84 2
✓VA`� Signal circuit(s)or limited-energy
Address: it 7 Ti 131L VG panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: �Q //(�e// /� Each additional inspection over allowable in any of the above
V(n,Itiwv Dvb
Additional inspection(1 hr min) 66.25/hr
Phone:(AO)—`657 —7 t5.1 Fax:( ) Investigation(I hr min) 90.00/hr
Email: EgrAvi'.? y Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00i hr
CCB Lic.: ) €(51.IS2 Electrical Lic.:37_7 rv.Lic.: y 76 el specifically listed O5 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,require Lob » Subtotal: 1ST 8-2,_
Print name: 3";J(/‘ 606,41 Y'tv Date: 4/215/2 Z., Ifa_Plan Review Required(25%of permit fee): 3' .i S
( State surcharge(12%of permit fee): I V, 61
Authorized signatu TOTAL PERMIT FEE:
1 _
/ This permit application expires if a permit is not obtained within 180
Print name: 0 W t.�GituaJ t Date: b/Z 157e , days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE_duc Rev 06/17/2015 440-4615T(t 1/05/COM/WEB
Del; te/rl) t I2(21
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
5.01 to 15 kva 133.56 2
n Audio 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* >100 kva(fee in accordance 2
with OAR 918-309-0040) 552.26
I I 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:
Each additional inspection is 66.25i hr 1
• Other. charged at an hourly(1 hr min)
Inspections for which no fee is 90.00'hr
specifically listed(V,hr min)
• ELECTRICAL PERMIT FEES -
COMMERCIAL WORK ONLY: Subtotal(Enter on Page I):
Fee for each commercial system: $75.00 • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n D• ata Telecommunication Installation
PI F• ire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
I-1 M• edical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
fI Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1',\Building`TermitstELC_PermitApp_ELR ERE.dor Rev 06i172015