Permit Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard RECEI\ /E ,Dalei3y tpy y �
111 . • 13125 SW Flail Blvd.,Tigard,OR 972231 ` v V , //� t 1Z1 '/Zu" �y
Plan Review ,y�
,S Phone: 503.718.2439 Fax: 503.598.1960 Date/By: /I !�/9 �'V ® 2Z+�/�612-_
Inspection Line: 503.639.4175 1 ReadyDate/By: ` orris: (�"
TIC'AR OCT 1 2022 �Ib' See age2for
Internet: www.tigard-or.gov Notified/Method: (/
I Supplemental Information
TYPE OF WORK CITY OF,( TIUAiV ;01 dA. PLAN REVIEW
El New construction ❑AdditiOrl/alteratlON Ant¢Atp/VI ii1('\ Pleae check all that apply(submit 2 acts of plans w/items checked):
0 Service or feeder 400 amps or more ®Building over three stories.
❑Demolition ❑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 El Commercial/industrial ElAccessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
®Multi-family ❑Master builder ❑Other:
El Fire pump. 0 Installation of 150 KVA or
I(3 `r�S JOB SITE INFORMATION AND LOCATION 0 Emergency system larger separately derived
Job#: 2 0 0 5 3 0 I I--Job site address. 1132 - SW N a e ve St Bldg 100HP 1 ❑Add HP o of new motor load of system.
or more. ❑"A","E","I-2","I-3",
❑six or more residential units. occupancy.
City/State/ZIP: Tigard, OR 97224
❑Healthcare facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#:B 1 dg 1 I Project name: Pacific Ridge ❑Hazardous locations. 0 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 Qty. 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 1 168.54 16 8 . 5 4 4
Ea.add'I 500 sq.ft.or portion 1 33.92 33 . 92 1
DESCRIPTION OF WORK
New Construction Multi Family— 36 Units 35 Remaining units at 50% MF
S101 .23 x 35 = $3543. 05
Largest Unit 1250 Sq Ft
0 PROPERTY OWNER Renewable Energy I 0 See Page 2
❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 1 100.70 100 . 7 2
Address: 201 amps to 400 amps 133.56 2
I^ 401 amps to 600 amps 200.34 2
City/State/ZIP:
r-A 601 amps to 1,000 amps 301.04 2
Phone: ( ) Fax:( ) Over 1,000 amps or volts 1 552.26 552 .26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
1r f' 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
Branch circuits—new,alteration,or extension,eer panel 0 APPLICANT ❑ CONTACT PERSON
A.Fee for branch circuits with
Business name: Prairie Electric, Inc above service or feeder fee, 17 7.42 126. 14 2
each branch circuit
Contact name: Anita Paso B.Fee for branch circuits without
Address: 6000 NE 88th Street an hcie rfurcuitt fee,first
branch c 56.18 2
br
City/State/ZIP: Vancouver, WA 98665 Each add'I branch circuit 7A2 2
Miscellaneous(service or feeder not included)
Phone:( 5 0 3) 2 8 6 . 9 2 0 9 Fax: :(3 6 0) 576 . 7422 Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: anitap@prairielectric . com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Prairie Electric, Inc Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy Address: 6000 NE 88th Street panel,alteration,or extension. ® See Page g 2 300 2
City/State/ZIP: Each additional inspection over allowable in any of the above
y Vancouver, WA 98665 Additional inspection(1 lir min) 66.25/hr
Phone:(5 0 3) 2 8 6 . 9 2 0 9 Fax:(3 6 0) 5 7 6 . 7 4 2 2 Investigation(I hr min) 90.00/hr
cornIndustrial plant hrmin) 78.18/hr Email: anitap@prairielectric . co
Inspections for which no fee is
CCB Lic.: 60178 Electrical Lic.: 3 7—4 91 c Suprv.Lic.: 5 9 8 6 S specifically listed('A hr min) 90.00/hr
�/ .�[�� ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: .n A � '1 """`!" Subtotal: 4824.61
Print name: Rod S . Halberq %fit Date: 10 . 7 . 22 ❑Plan Review Required(25%of permit fee): 1206.15
State surcharge(12%of permit fee): 578 . 9 5
Authorized signature: TOTAL PERMIT FEE: 6 6 0 9.71
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I'nuildinglPermitstELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(I I/05/COM/WEB
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 Qtr. I Each I Total )
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: s 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:
❑ Burglar Alarm 25.01 to 501aa 301.04 2
n Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
PI Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* y
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:
Ti Other: Each additional inspection is 66.25/hr 1
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(Y hr min)
COIVINIIi RCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page I):
• Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
Boiler Controls
❑ Clock Systems
LI Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ N• urse Calls
❑ Outdoor Landscape Lighting*
❑ P• rotective Signaling
n Other:
Total number of commercial systems: 1 x 4 floora
*No licenses are required. Licenses are required for all
other installations
I:BuildingiPermils\ELC_PermitApp_ELR F.RE.doe Rev 06/17/2015