Permit (8) CITY OF TIGARD ELECTRICAL PERMIT
N ' COMMUNITY DEVELOPMENT Permit#: ELC2023-00531
TiGAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/12/2023
Parcel: 1 S135CA00800
Jurisdiction: Tigard
Site address: 11255 SW GREENBURG RD 33
Project: Tigardville Apartments Subdivision: None
Lot: None
Project Description: Reconnect only.
Contractor: Owner: TIGARDVILLE APARTMENTS LLC
1233 NW NORTHRUP ST STE 125
PORTLAND, OR 97209
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
Specifics: 1 ea Reconnect Only 09/12/2023 $67.84
1 ea 12%State Surcharge- 09/12/2023 $8.14
Electrical
Type of Use: MF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001- .`You ,pbtain a cony of the rules or direct auestions to OUNC by calling 503.232.1987 or 1.800.332.2344..
Issued By: 1 `��p-Jm Permittee Signature: 71.9 �-/ t t
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.
RECEIVED I
Electrical Permit Application FOR OFFICE USE ONLY
An 3' t 2023
City of Tigard Received /�v ZZ 77 o t<rrtdt x:i. e�j
t 13125 SW Hall Blvd.,Tigard,OR 97223.: Dan Rev 25( J- t: D,}'3J- �.)(, i
lq C Phone: 503.718.2439 Fax 503.598,1960' �LW TIGARC� PIDseBeiew
RelaadPemiltll:
``ll Inspection Line: 503.639.4175 : !I Ready DaleBy: 7. ® See Page 2 for
TIGARpG DIVISION
n Internet: www.tigard-or.gov NaiftedlMedwd: jettsitailiLMM.
S I gupplemeoW tafamation
i ar' _Ti, r..TYPLOF'WORK�;. k ÷ •{ PLAN.REYIEW; Z '
El New construction ❑Addition/alteration/replaeement Please check ell that apply(submit j sets of plans wfitems checked):
0 Service or feeder 400 amps or more ElBuilding over three stories.
El Demolition El Other;
where de available fault current ❑Marinas end boatyards.
.41W- -, _ CAT:EG.oktrotiert ssTRUCTIO ITT- , exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling ❑Commercia]/industrial 0 Accessory building less to ground or exceeds 14,000 ❑Commercial-use agricultural
Multi-familyamps other installations. buildings.
la El builder ❑Other: ❑Fire pump.
np, ❑Installation of 150 KVA or
Wilialrr _
> ,AV OR'srrE,I1.VF,ORMATION AND,)EOCARTONr I'arar ❑Emergency system larger separately derived
Job#: Job site address: t I Z ? S'U �c�i1,ouYT ❑1o011P or Additionof
mote load of system
L5ry/Siate/ZIP:I%(nla a Ole-- -1 1 2� 3 ❑Six or mom resident. emits. °CcrP°OOy,
Vf ! ❑Health-rare Facilities. ❑Recreational vehicle puke.
Suite/bldgJapt.#: 2 7- Project name: ❑Hazardous locations. 0 Supply voluge far more than
❑Service or feeder 600 amps or more. 600 volts nominal
Cross street/directions to job site: ; EEzSCREDl1I,E';. •'•.,_,,. i
Demiodes i tor. I Each I Taw 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'1500 sq.ft.or portion 33.92 1
"._.„ardl'.`..., .. DESCRHtT10I! O1(.(i,W,ORK fi -'?.PF'' ' - Limited energy
(�,, r. ,residential 75.00 2
COrn�l� C3V\ " re CO e (with above sq.ft.)
,., 1� Limited energy,multi-family 75.00 2
CPOW e- residential(with above sq.it.)
Renewable Energy ❑ See Page 2
OP'.'•..'®'PROPERTY'OWNER'.,s .--!.I L. '" 0 TENANT law Services or feeders installation,alteration,and/or relocation
Name:Tl r,O,)('(k,V k`1 e, '\C., 200 amps or less 100.70 2
Address: "itJ' ,,?j'7j N)\JJ N vet/kw 0)tQ Si- - ' \2J5 201 amps to 400 amps 133.56 2
�CA- rr o� t 12i 601 amps to 1,0 0 ans 301.04 2
City/State/ZIP: Tw1 �1 t _t 601 amps to(,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 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,per panel
'r-, ` 102KOP,i,IGA-.. ., .' y i - 145 :O CONTACT:,PERSON
A.Fee for branch circuits with
Business name:Legate 17nDf]vf4+ , n0.�e -'ir. above service or feeder fee, 7.42 2
_) Y Yam'^ �"1 each branch circuit
Contact name: B.Fee for branch circuits without
I��Li� service or feeder fee,rust
Address: ` i 1 I -w, Ave S \Q'Z branch circuit56.18 2
City/State/ZIP: GifaC cuirkc is . `t'i0\5 Each add'I branch circuit 7.42 2
Phone: Fax:: Miscellaneous(service or feeder not included)
(S�)-1 ICFJ—Ci 4-1 ( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: sir-torvx_ru.ie. _al ..LiY\W • C.dVY\ Reconnect only I 67.84 19,
„.. ' .`..V1160W.V24.GOCVT1d4 oR tr,,...N .tf ',`.,,r,. .. • Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
/' �,, Signal circuit(s)orlimitcd-energy
Address: cLL'Jvlr'ci'- C)al tiG Covi./Ycede`v^ panel,alteration,or extension.
0 See Page 2 2
\ll___ / Each additional inspection over allowable In any of the above
City�ate/Z1P: �'
Additional inspection(1 hr min) 66.25/hr
Phone:( ') F . ) Investigation(l hr min) 90.00/hr
Email: ---
""`^ industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: lectrical Lie.: `` Suprv.Lic.: specifically listed(1/2hr min) .
Suprv.Electric ignature,required: ` . .-; ELEgERICAL;PF,R Subtotal:
P- e: Date: ESf ` , . . . .
`.. ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature:
,, �,�s/^ ,.,_1TOTAL PERMIT FEE: ''i j Ater
TIaN v -A� ,t rM Di,fit 11 This permit days a application aspires ifs permit is rot obtained within 7g0
Print name: 1 Oi. Ql Date: ✓vr carsafterirhas been dperpaccepted meompkh.
may/'' J • Number of inspections allowed per permit
1:1BWldiag'PemurlFLC_PesmhApp_ELR EIkE.doe Rev 0641/2015 440.4615T(IINSICOM'WEa
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
'-^RESIDEN AIWWORK7ONLY:. .. t • Alowsw,. "'1:.';,:.ItEac UE--bO
ll residential systems combined: $75.00 Renewable 1 Qe i e'm 1 r.t.1
•
Fee for I
L Y Reaewabte electrical energy systems:
5 kva orless 100.70 2
Check Type of Work Involved:
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to25kva 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
El Garage Door Opener* 5100 kva(fee in accordance 55226 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >too kva-no additional charge 0.0 3
Each additional Inspection over allowable In an of the above:
❑ Other: Each additional inspection is 66.25/hr1
charged at an hourly(1 he min)
Inspections for which no fee is 90 00/hr
specifically listed Oh hr min)
COMMEMIA4L 1'ORICONLY °-` . NNW?ktEtTlit ft P,ER11f1T,F.E
Fee for each commercial system: $75.00Subtotale genenter t.o Page 1):
Y • Number of inspections allowed per pemdt.
(SEE OAR 9I8-309-0000)
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*
El Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
❑ Other:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
1:1awldth Pefmaslel.C_PmautApp_ELR ERadoc Roe 06/17/2015