Permit a CITY OF TIGARD ELECTRICAL PERMIT
1:111 s ; COMMUNITY DEVELOPMENT Permit#: ELC2013-00563
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/24/2013
Parcel: 2S114AA00200
Jurisdiction: Tigard
Site address: 16285 SW 85TH AVE 410
Project: River City NW Mechanical Subdivision: 1993-078 PARTITION PLAT Lot: 2
Project Description: (1)branch circuit for RTU and(1)circuit for GFI outlet.
Contractor: METRO ELECTRIC INC Owner: WH SHIPMAN LIMITED
3860 SE PELTON AVE BY NORRIS&STEVENS INC
TROUTDALE, OR 97060 621 SW MORRISON STE 800
PORTLAND, OR 97205
PHONE: 503-666-2159 PHONE:
FAX: 503-674-0123
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 09/24/2013 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/24/2013 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 apy cable 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 i wor ': p-nded for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificatio Cente T-*1,1 l- ar- set forth in OAR
952-001-0010 through OAR 952-001-0090. You n- •• - .. _o. of the rules or direct questions to OUNC by calling 503.2 2.19' / .. / .
4111111P _
Issued By.'" ` _ _=� Permittee 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 Application FOR OFFICE USE ONLY
Received ` _
City of Tigard Date/By: 4i -J(3 Permit No.: �z_c_kr)I'3.-, -056 'R'
1,1 g 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
' C ' • Phone: 503.718.2439 Fax: 503.598. \\I Date/By: Other Permit:ey-113 C l 3—eft3S 7 —
FtGARD w
Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
. . Internet: ww .tigard-or.gov • r10\'
Notified/Method: . Supplemental Information
. TYPE OF WORI( .Q ,%• ' ® ' , PLAN REVIEW, • •
•
❑New construction ddition/alteration/reD1�.11 �� Please check all that apply(submit 2 sets of plans w/items checked below):
\ V` ``1\S'��� ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: Cj ` C.to where the available fault current ❑Marinas and boatyards.
' CATEGORY. OF'CONS� N exceeds 10,000 amps at 150 volts or ❑Floating buildings.• less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ l-and 2-family dwelling OCommercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
. , ❑Emergency system. larger separately derived system.
JOB'SITE INFORMATION, AND ,LOCATION 0 Addition of new motor load of ❑"A","E","1-2","I-3",
Job no.: Job site address:16i ® C r -"k\A- „y� I OOHP or more. occupancy.■'�, ,e C� 0`+e t� ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: 1� r �W,�J� ❑Health-care facilities. ❑Supply voltage for more than
t art _c ' v ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:, Li`v • yojes name: "1'Vp f- citta A44./ 1i_PA A w ttC Service or feeder 600 amFpEs E or mSCorHe.
EDULE.,
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.)ACLCCA0 � ./ c,,- c,,,-- N
Limited energy,tial(with muabfve iq.
residential(with above sq.ft.) 75.00 2
� Renewable Energy ❑ See Page 2
K r- 90 sO Z )\ -�Q�_ C^. ,
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 ex_tension,per panel
II APPLICANT . _ 1 • 0•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 E
Contact name: service or feeder fee,first 56 18 5Z,..1 O
2
branch circuit
Address: Each add'l branch circuit i 7.42 7,9-17F
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
Phone:( ) Fax: :( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
,p / CONTRACTOR' _ Sign or outline lighting 67.84 2
Business name://le,TI`U lC Signal alteration,orli tens energy See ft
panel,alteration,or extension. Page 2 2
Address: c35' ,O �� Lo � v� Each additional inspection over allowable in any of the above
v` Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: `�t20(_e e... cD-La , 1 —7 CK09 0 Investigation(I hr min) 66.25/hr
Phone:(56J ) _(9.16-"V Farx::(� A.,) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.:`7 I'?.5 Electrical Lic.: , , , f Suprv.Lic.:664 specifically listed(V2 hr min)
�// // y ,� r 1 ELECTRICAL PERMIT''FEES
S
•
uprv.Electrician sigHalturte,required: ./�� - ��� Subtotal: (p 3 , (pO
Print name: h i`� �-�so Date:a[/ Ste i 3 Plan review(25%of permit fee):
�� State surcharge(12%of permit fee): -7,c 3
Authorized signature: TOTAL PERMIT FEE: -7f,0L3
This permit application expires if a permit is not obtained within 180
Print name: Date:
days after it has been accepted as complete.
* Number of inspections allowed per permit.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined ... $75.00 Description I Qty. I Fee I Total I
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ 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
OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning
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
❑ Each additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly(I hr min) 66.25/hr
Inspections for which no fee is 90.00/hr
specifically listed(Y.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:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
t Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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