Permit q CITY OF TIGARD ELECTRICAL PERMIT
C ' • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00526
T t G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/13/2012
Parcel: 1 S 135BD00300
Jurisdiction: TIGARD
Site address: 9735 SW SHADY LN 103
Project: Tigard Medical Mall Subdivision: ASHBROOK FARM Lot: PTS 5 &
Project Description: (1) branch circuit to reconnect condenser.
Contractor: WILLAMETTE HVAC LLC Owner: MCFADDEN, ARTHUR L
3075 SW 234TH AVE. #206 BY SKLARZ, ERIC
HILLSBORO, OR 97123 621 SW MORRISON ST, STE 800
PORTLAND, OR 97205
PHONE: 503 - 259 -3200 PHONE:
FAX: 503 - 848 -2597
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 09/13/2012 $56.18
Specifics: Service or Feeder -
1 ea 12% State Surcharge - 09/13/2012 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 d n accor a ith 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
day . ATTENTION: Orego law re• • re yo to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 -001 -0010 through OAR 952 -00 109. o: obtain a copy of the rules or direct questions to OUNC by calling 503.232.19§2-or d : 00.33 .'344. /
1 /
I ued By: � / Permittee Signature: . •m_411401 .
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' 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 Applicatiow FOR OFFICE USE ONLY
Il II����LL Received p �07 t
City of Tigard Date /By: ( /..2. No.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review � ��/ 1 RREREEESE
_ Phone: 503.718.2439 Fax: 503.598.1960 ' 3 2012 Date/By: Other Permit: r'
T I G AR D Inspection Line: 503.639.4175 Date Ready /By: Juris: El See Page 2 for
Internet: www.tigard - or.gov CITY OFTIGARD Notified/Method: _ ❑upplementalInformation
TYPE oFBAANING DIVISION PLAN REVIEW
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I - and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: 9735 SW Shady Ln 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard OR ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
' Suite /bldg. /apt. no.: Suite103 Project name: Tigard Medical mall ❑ Service or feeder 600 amps ormore.
- FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
Reconnect condenser residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
• 401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: same as below B. Fee for branch circuits without
service or feeder fee, first I 56.18 S�- r " 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each dwell ng, service City /State /ZIP: 67.84 2 or modular
and/or feeder
Phone: ( ) Fax: : ( )
Reconnect only ' 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited energy
Business name: Willamette hvac LLC panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 3075 SW 234 Ave Suite 206 Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Hillsboro, OR 97123 Investigation (I hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 259.3200 Fax: (503) 848.25 Inspections for which no fee is 90.00 / hr
specifically listed (V: hr min)
CCB Lie.: 56951 Electrical Lie.: 34346CRE u rv. Lic.: 4025LEB ELECTRICAL PERMIT FEES �, l �
Suprv. Electrician signature, required: (25% Subtotal: (O�l
Plan review (25 /o of permit fee):
Print name: (' /• k c si' c &ro Date: VA).779,...---• State surcharge (12% of permit fee): `p. 7� TOTAL PERMIT FEE: 67,„ _9 Z
Authorized signature: C71 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Michael Malstrom Date: 9/12/12
• Number of inspections allowed per pennit.
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(I1 /05 /COM/WEB
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9735 SW SHADY LN 103, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
03/22/2013 00:00
ELC2012-00526
PASS - No C of O
Violation Summary:
Inspector Contractor