Permit (4) CITY OF TIGARD ELECTRICAL PERMIT
,1114
I COMMUNITY DEVELOPMENT Permit#: ELC2022-00169
JIG A R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 4/18/2022
Parcel: 1 S126CC00200
Jurisdiction: Tigard
Site address: 10065 SW CASCADE AVE
Project: Tesla Subdivision: None Lot: None
Project Description: Electrical for TI.
Contractor: JC ELECTRIC INC Owner: 10065 SWC LLC
118 NW 184TH STREET BY ALSTON&BIRD LLP
RIDGEFIELD,WA 98647 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
4 ea Services or Feeders-200 04/15/2022 $402.80
Specifics: amps or less
1 ea Services or Feeders-401 to 04/15/2022 $200.34
Type of Use: COM 600 amps
Class of Work: ALT 120 crt Branch Circuits w/Purchase 04/15/2022 $890.40
Type of Const: Service or Feeder
Occu anc Grp: 1 ea Signal circuit or Limited 04/15/2022 $75.00
p Y
Energy Panel
1 ea Plan Review Electricial 04/15/2022 $392.14
1 ea 12%State Surcharge- 04/15/2022 $188.22
Electrical
Total $2,148.90
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 through OAR 952-001-0090. You av o tain a coov of the rules or direct auestions to OUNC by callina 503.232.1987 or 1.800.332.2344.
Issued By: :;rr,'v/) Permittee Signature: "' -X1121
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.
'�i`°
Electrical Permit ApplicatiotE
EIVEC
City of Tigard Received ,� W In q Dan Rev (0 Permit#. t C 20
13125 SW Hall Blvd.,Tigard,OR 97223MAR 1 0 2022 , ELs..GI`J�����
B 11111
Plan Review
Phone. 503.718.2439 Fax- 503.598 19b Date/By: �/ L Related Permit a.
Inspection Line: 503.6394175 1 I T OF I ARD �( ` .
P Read DattB '� lur'
[WAR!) Y ® See Page 2 for
- Internet: www.tigard-orgov 'WILDING DMSIOfr
Notified/Method or Supplemental Information
TYPE OF WORK t r , y,leA#16 , PLAN REVIEW
❑New construction 21,.Additionialterationheplacement , Please check all that apply(submit 2 sets of plans w:items checkedl-
'A Service or feeder 400 amps or more 0 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 0 Floating buildings
❑ I-and 2-family dwelling Commercial+industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for ail other installations buildings
❑Multi-family 0 Master builder ❑Other:
0 Fire pump 0 Installapon of 150 KVA or
JOB SITE INFORMATION AM) LOCATION 0 Emergency system. larger separately derived
e_
Job#� Job site address:�Vvb�r0 Addition of new motor load of system.
G AUG.ArcIOOHP or more. ❑"A" "E" "I-2'"l-3"
' City-State/ZIP: To -J, 0, b� G'"7 Zt 3 ❑Health-careSix more residential units Recreational
c tioy
❑ facilities. 0 vehicle parks.
i Suite/bldg.•apt.#: Project name:res I . J p 0 Hazardous locations. 0 Supply voltage for more than
" --- ig Service or feeder 600 amps or more 600 volts nominal
Cross street'dtrections to job site: FEE SCHEDULE
Dese ..ion , Qt}• ; Each Totat _
New residential single-or multi-family dwelling unit.
Subdivision: Lot# Includes attached garage.
1,000 sq.fl.or less 168.54 4
Tax rnap`parce) d: -µ Ea.add'I 500 sq.ft or portion 33.92 1
DESCRIPTION OF WORK ..
„, „„_•_..e Limited energy,residential 75.00 2
[€Vl4tV bV-i Id 0, t- {) r„ ?ks (with energybove,
li
_! WT J j Limited energy,multi-family 75.00 2
residential(with above sq.ft)
----..- Renewable Energy 0 See Pa e 2
— li - ••-
a PROPERTY OWNER I ❑ TENANT
..... --- feeders instal
Services or lation,alteration,and/or relocation _
Name: 200 amps or less E.) 100 70 '1 oz.102
Address. 201 amps to 400 amps 133.56 2
— 401 amps to 600 amps I 200.34 2 2
CityState'ZIP: r 601 amps to 1,000 amps 301.04 2
Phone:( ) 7pax; ( )� , Over 1,000 amps or volts 552.26 s 2
Email:
Temporary services or feeders installation,alteration,and.lor
relocation
Owner installation:This installation is being made on property that I own which is not i 200 amps or less i 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 I . 168 54 2
0 APPLICANT 0 CONTACT PERSON B arB ar och circuits-new,alteration,or extension,der panel
------ ._ A Fee for branch circuits n uh
Business name: above service or feeder fee, ta p 7.42 ,d 004i0 2
each branch circuit
Contact name: B.Fee for branch circuits iiuhoirt --
E service or feeder fee,first 56 18 2
Address: branch circuit
City'State.'ZIP: Each add'I branch circuit 7.42 2
' — Miscellaneous(service or feeder not included)
^ ""`Phone.( ) Fax: :( ) Each manufactured or modular 67 84T 2
Email - 4 n j �� eco R
_ service and/or feeder
r7 W (Jr l a Reconnect only 67 84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name 4.... j fez.,,)f,s•£_fi 1 ..c` Sign or outline lighting 67.84 2
*L - ---'-----, Signal circuit(s)or limited-energy AIN
Address t("� Ave_ See Page 2 7Sd)2
t'� f y e, anei alteration or extension r
Ct ZIP: { -
Each additional inspection over allowable in any of the above
ty;State; V(.r?i tAVQ/ I.-J,�} l?�66.�
l Additional inspection(I hr min) � 1 66.25 hr
Phone:(340)_ 6157.. 7B15 i Fax:( ) : Investigation(l hr min) I 90.00 hr
Email: }^' Industrial plant(1 hr min) ! 78.18 hr
* !G1W1r, S .t/�J inspections for which no fee is
CCB Lie.: 111({S-Z Electrical Lie.: 37_ Suprv.Lie.: 96/irtS1 crftcall listed hr min) 90A0-hr
- ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: Ca.'
Print name: 504 Cou.'; , Date 3/47 2Z ®Plan Review Required(254,6 of permit fee): Z.f
State surcharge(12%of permit fee): f a 2.Z-
Authorized signature: TOTAL PERMIT FEE: i N a�e
Yr
This permit application expires if a permit is not obtai d within 180
I Print name; " t E Date: ' /� days after it has been accepted as complete.
• ivur. r of inspections allowed per permit
1 BudduigiPermiis.ELC_PcrmiiAp_ELR ERE.doc Rev 06/172015 440-4615TII1•05,COMiWEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
I Dacdpnoa RESIDENTIAL WORK ONLY: FEE SCHEDULE
I Qty. f Each ! Total I
Fee for all residential systems combined: S75.00 Renewable electrical energy systems:
Check Type of Work Involved: s kva or less 100.70 2
i 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 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* -100 kva(fee in accordance
552.26 2
with 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:
❑ 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(',hr min) t
`COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
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
S.Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other: J
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I @.uddmg\Pcimits\ELC PcrmiiApp ELR ERE.doc Rev06/1T 2015