Permit CITY OF TIGARD ELECTRICAL PERMIT
�1 COMMUNITY DEVELOPMENT Permit#: ELC2013-00548
TI GARD 13125 SW Hall Blvd.,Tigard OR_97223 503.718.2439 Date Issued: 09/16/2013
Parcel: 2S 112 DA01000
Jurisdiction: Tigard
Site address: 6610 SW CARDINAL LN
Project: Umpqua Bank Subdivision: 1995-098 PARTITION PLAT Lot: 1
Project Description: (1)branch circuit and(1)low voltage for fire alarm for FACP upgrade for elevator recall
' Contractor: STONER ELECTRIC Owner: PACIFIC REALTY ASSOCIATES
1904 SE OCHOCO ATTN: N PIVEN
MILWAUKIE, OR 97222 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224.
PHONE: 503-462-6500 PHONE: 503-624-6300
FAX: 503-659-2765
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 09/16/2013 $56.18
Specifics: Service or Feeder
1 ea Signal circuit or Limited 09/16/2013 $75.00
Type of Use: COM Energy Panel
Class of Work: ALT 1 ea 12%State Surcharge- 09/16/2013 $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 ne in accordance with pproved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
ays. ATTENTION: Oregon la\w, r--••es you to follow the rules adopted by the Oregon Utility Notification Center.' Th• a rules are set forth in OAR
952-001-0010 through OAR 952-00-0090 .0 may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1. 7 or 1 .- r• 32.2344. /
7
Issued By: � L_/ Permittee Signature: /►� -_ :_ a:
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:
CONTRACTO INSTALLATION ONLY .
•
SIGNATURE OF SUPR.ELEC' 49 ��".....__ Date:
LICENSE NO. •
• • Call 503.639.4175 by 7:00 a.m:,fofthe next available inspection date.
This permit card shall be kept in a conspicuous piace?on the:job site until completion of the project.
. Approved plans are required on the:job site atthe,tlme of each inspection.
Electrical Permit Applica:r ■ . CEIVED FOR OFFICE USE ONLY
Received 9 A 9 / A
City of Tigard 1 6 Date B : 7 PermitNo.:�LC'�' QQS
1,1
a 13125 S W Hall Blvd,Tigard,OR 9223 `-il'- Nan Review
0 Phone: 503.639.4171 Fax: 50 .19 Date/B : Other Permit:
T I GA RD Inspection Line: 503.639.4175u y 0 OF TIGARD Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK 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","l-2","1-3",
Job no.:iezav Job site address: 66 ID 5;1/4/ c D Arm_1A Six or or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: �ARO 0 ❑Health-care facilities. ❑600vlolts nominal. more than
❑Hazardous locations.
Suite/bldg./apt.no.: Project name: Lim"62,4 4_A.740.,& ❑Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
J 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'l 500 sq.ft.or portion 33.92 l
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 �2
Limited energy,multi-family 75.00 12
w„� ., ,e,�Eev "cP ....71-, ,,. ,.-, tE4. ' residential(with above sq.ft.)
Services or feeders installation,alteration,and/or relocation
5 /S-72Vif ? .C7Le✓ / ��A-t!.._ 200 amps or less 100.70 2 "
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
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
El APPLICANT CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name:..jc o. .iS /,vc B.Fee for branch circuits without
service or feeder fee,first
Contact name: J �N/3 W�7�Mg branch circuit L 56.18 ,�8 2
�, /
Each add'l branch circuit 7.42 2
Address: f Sk-G pG'd Miscellaneous(service or feeder not included)
City/State/ZIP: p� Each manufactured or modular 67.84 2
/�44_,Ill/Q1ik* /`Zz dwelling,service and/or feeder
Phone:( ) _-52.4. Fax: :,f 3) e6-7—1966 Reconnect only 67.84 2
��lH/.SW l ref—Yfl LJLt'�• CL) 14
Pump or irrigation circle 67.84 2
E-mai • p/. �
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s)or limited-energy / ji PD is'
Business name: STONER ELECTRIC, INC. panel,alteration,or extension. I , Paget 75 DC 2
Each additional inspection over allowable in any of the above
Address: 1904 SE OCHOCO Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
City/State/ZIP: MILWAUKIE, OR 97222 Industrial plant(1 hr min) 78.18/hr
Phone:(503) Fax:(503) 659-4968 Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
CCB Lic.:44823 Electrical Lic.:26-122C Suprv.Lie.: 3496S ELECTRICAL PERMIT FEES
Subtotal:ari31,03
Suprv.Electrician signature,required: v- Plan review(25%of pennit fee): ,e'
Print name: MICHAEL FALCONER Date: 9/l,,j/3 State surcharge(12%of permit fee): /5,74
TOTAL PERMIT FEE:it/L4o, it
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per pennit.
I:\Building\Permits\ELC-PermiiApp.doc 07/01/10 440-4615T(I1/05/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:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
n Heating,Ventilation and Air Conditioning.System*
❑ Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
nData Telecommunication Installation
Fire Alarm Installation
n HVAC
❑ Instrumentation
nIntercom and Paging Systems
n 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