Permit CITY OF TIGARD ELECTRICAL PERMIT
S; COMMUNITY DEVELOPMENT Permit #: ELC2013 -00179
T ICARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/20/2013
Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15957 SW 72ND AVE
Project: Bikram Yoga Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
Project Description: (1) 200 amps or less and (17) branch circuits for TI
Contractor: KEC ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES
761 SW BAILEY AVE ATTN: N PIVEN
HILLSBORO, OR 97123 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 439 -0904 PHONE:
FAX: 503 - 640 -3838
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 03/20/2013 $100.70
Specifics: amps or less
17 crt Branch Circuits w /Purchase 03/20/2013 $126.14
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 03/20/2013 $27.22
Electrical
Type of Const:
Occupancy Grp:
Total $254.06
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 issue; e, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificatio,/ Center. Those .ales are set orth in OAR
952- 001 -0010 through O {{
52 -001- 0090. You may obtain a copy of the rules or direct questions to OUNC by calling 50:232.1987 or2344.
By: Issued B e wL- - hf'� 0 P ermittee 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' 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 ApplicationREEIVED FOR OFFICE USE ONLY
City of Tigard Received Dateiv ( 3 Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 MAR 20 2013 Plan Review `� 02.201 ��U�17 q
eview - I.
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: p� 1 3- 000 Y g--
TIGARD
Inspection Line: 503.639.4175 C OF TIGARD Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: 1/ ca Supplemental Information
BUILDING DIVISION
TYPE OF WORK PLAN REVIEW
❑ New construction ddition/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 F CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
El 1- and 2- family dwelling ommerciaUindustrial ❑ 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.
C../ ❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ",
Job no.: /3--/o r S Job site address: / ✓`N -7 ) — 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: . / ❑ Health -care facilities. ❑ Supply voltage for more than
` r ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: ✓ Project name: 4/�1v9 yi6-,9 ❑ Service or feeder 600 amps or more.
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
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family
(Q L 7 16 9 ( Dr_rr C9/ T residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less / 100.70 2
❑ PROPERTY OWNER ❑ 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, y
7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
ty dwelling, service 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
<' ' panel, alteration, or extension. Page 2 2
Business name:
�� 6 - 7 - r , ti w/��''9 `� Each additional inspection over allowable in any of the above
Address: >C / S 4„1-( 4 2,.... e Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: /, S4a'D Br 7 /2 3 Investigation (1 hr min) 66.25/ hr
/ Industrial plant (1 hr min) 78.18 / hr
Phone: (50) t 3 q B 9 o Y Fax. ( ) Inspections for which no fee is
ll"" specifically list (% hr min) 90.00 / hr
CCB Lic.: Electrical Lic.: 3q -( Suprv. Lic.: �(C($ 5 S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: - o Subtotal:
Plan review (25% of permit fee):
Print name: . ,,,, e (S' C..4_,,,,/ l ate: 3/ 0 / 3 State surcharge (12% of permit fee):
1 ° TOTAL PERMIT FEE: jslilf 0(
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number o inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440 -4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 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*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \ Building \Permits\ELC- PermitApp,doc 07/01/10
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
15957 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Electrical
199 Electrical final
04/29/2013 00:00
ELC2013-00179
PASS - No C of O
Bath fixtures to be checked at building final
Violation Summary:
Inspector Contractor