Permit CITY OF TIGARD ELECTRICAL PERMIT
311 COMMUNITY DEVELOPMENT Permit#: ELC2013-00520
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/03/2013
Parcel: 1 S134BC00300
Jurisdiction: Tigard
Site address: 12240 SW SCHOLLS FERRY RD
Project: Rite Aid Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: Replace EMS panel, Low voltage wiring for HVAC
Contractor: INDUSTRIAL COMMERCIAL ELECTRIC COMPANY Owner: FW OR-GREENWAY TOWN CENTER LLC
29030 SW TOWN CENTER LOOP E, STE. 202 PO BOX 790830
#159 SAN ANTONIO,TX 78279
WIILSONVILLE, OR 97070
PHONE: 503-981-2383 PHONE:
FAX: 503-981-0053
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 09/03/2013 $56.18
Specifics: Service or Feeder
1 ea Signal circuit or Limited 09/03/2013 $75.00
Type of Use: COM Energy Panel
Class of Work: ALT 1 ea 12%State Surcharge- 09/03/2013 $15.74
Electrical
Type of Const:
Occupancy Grp:
Total $146.92
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 done in rdance 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. ATT NTION: Oregon =w re.uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0 10 through OAR 952-081 :r 90. Y% may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1•:7 or 1.800.332.2344.'
Issued /I Permittee Signature: �� i�
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:
CONTRA TOR INSTALLATION ONLY
i► 04/
SIGNATURE OF SUPR.ELEC' „f', . ' Date: S3/)3
'
LICENSE NO. 31 bS
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.
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Electrical Permit A licat • , WED FOR OFFICE USE ONLY
1 Received Permit No.:
City of Tigard • Date/B : 9 / 5 F�C'�/�-QO So"�p
13125 SW Hall Blvd.,Tigard,OR 94112,Q3J 3 2013 Plan Review
C ' Phone: 503.718.2439 Fax: 503.59 H60 Date/13 : Other Permit:
T I c;A I:D Inspection Line: 503.639.4175 CITY OFTIGARD Date Ready/By: tans: 63 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
OFk� -DIVISION•.TYPE
• PLAN REVIEW •a,41kr•:
El
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
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑ Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION' ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","I-2","1-3",
Job no.: Job site address: 1-2...2. j I00HP or more. occupancy.
(�6 C1 -I S O SG c S ref�� ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: 1 C r CA 0 R q 17-1--. ❑Health-care facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: g 1 Fe_Rid E. M S ❑Service or feeder 600 amps or more.
1 - FEE SCHEDULE ,
Cross street/directions to job site: Description j 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'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
(with above sq.ft.) 75.00 2
. DESCRIPTION OF.WORK ( q.
Limited energy,multi-family
75.00 2 c e L 'l j p a ry Q I . ww JD I}a �R (,J l r o f residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
M of e v I C e 5 Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
. AAPPLICANT. ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first / (j
56.18 S . I ZJ 2
branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
Phone: dwelling,service and/or feeder 67.84 2
( ) Fax: ( ) Reconnect only 67.84 2
E-mail: ft ty IC eC 0 Q.I eC h-i c o(-0m Pump or irrigation circle 67.84 2
CONTRACTOR . . - - Sign or outline lighting 67.84 2
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Business name: I I US h,t ) Signal circuit(s)or limited-energy See
0. Corn plef C tCat.,I r I eC • C U I 7
panel,alteration,or extension. Page 2 2
Address: 29 p 3 0 Scat I-0 4.j" (.e, \-cr p E c. 202_b')crA Each additional inspection over allowable in any of the above
City/State/ZIP: ( Additional inspection(I hr min) 66.25/hr
W 1 So m Li I t -e 0 R. c 7 07 0 Investigation(I hr min) 66.25/hr
Phone:(51.)3 ) q$ 1-22 v3 Fax:(' '3 ) 9 U + -0 p 5-3 Industrial plant(l hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: i 6 t13 6 Li Electrical Lic.: C 5 Z Suprv.L' .: specifically listed('/2 hr min)
ELECTRICAL PERMIT, FEES , �.?;:
Suprv.Electrician signature,required: (j� / Subtotal: 131; i b
/ (`/� Plan review(25%of permit fee
Print nam �v/v.c.5 C . l� r , fit- Date: 9 3 /j 3 ( P fee):
l State surcharge(12%of permit fee): 1 5; 7 Lt
Authorized signature: III I TOTAL PERMIT FEE: /�/6, 9 Z
ht.Print name: S 6 • 6 tf ri'% Date: C 1J / 1 3 This permit application expires if a permit is not obtained within 180
d lt^� days after it has been accepted as complete.
' Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE doc Rev 05/21/2013 440-4615T(1 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: I
Fee for all residential systems combined $75.00 I Qn. I Fee I Total I •
Description
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n Audio and Stereo Systems*
15.01 to 25 kva 200.34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
El Heating, Ventilation and Air Conditioning OAR 918-309-0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
ElOther: additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr
Inspections for which no fee is 90.00/hr
specifically listed('/z hr min)
COMMERCIAL WORK ONLY •.,. . , :ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
111 Audio permit application expires if a permit is not obtained within 180
Audio and Stereo Systems days after it has been accepted as complete.
Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
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❑ Instrumentation
❑ Intercom and Paging Systems
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❑ 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_ELR_ERE.doc Rev 05/21/2013
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