Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2014-00023
Date Issued: 01/16/2014
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: seg3436
Jurisdiction: Tigard
Site address: NO ADDRESS
Project: Main Street-Green Street Subdivision: Lot:
Project Description: Temporary electrical power for job trailer located on the south east end of Main Street.
Contractor: NORTHSTAR ELECTRICAL CONTRACTORS Owner:
19450 SW CIPOLE RD, STE 107
TUALATIN, OR 97062
PHONE. 503-612-0840 PHONE:
FAX: 503-612-0891
FEES
Quantity Description Date Amount
1 ea Temp Services or Feeders- 01/16/2014 $59.36
Specifics: 200 amps or less
1 ea 12%State Surcharge- 01/16/2014 $7 12
Type of Use: COM Electrical
Class of Work: ALT
Typo of Const:
Occupancy Grp:
Total $66 48
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 issuance. or if work is suspended for more the 180
days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the direct questions to OUNC by calling 2 1987 or 1 80332 2344
Issued Permittee Signature: i
C
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
City of Tigard / /4' /y ,� Permit No.: Z. ' O� — Dan
_ —ia 13125 SW Hall Blvd.,Tigard,OR 97223 plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit
T I G A R U Inspection Line: 503.639.4175 Date ReadyBy: tuns 65 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ❑Addition/alteration/replacement Please check all that apply(submit 1 sets of plans wlitems 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 "1 separately derived system.
❑Addition of new motor load of ❑"A","E","1-2","1-3°,
Job no.: Job site address: 100HP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZiP: ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations 600 volts nominal.
Suite/bldg./apt. no.: Project name: m iv-1 5'1- ❑Service or feeder 600 amps or more.
Cross street/directions to job site: Description FEE SCHEDULE
J I Q4• I Pte. I Totat 1 "
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'/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
.fir 75.00 2
e p pL k -e✓ --t t_' r \ U b T t I-e r residential(with above sq .)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER I ❑ 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/ZtP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less / 59.36 , 9.3r I
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
��� '�0 AprcAN'T ! CI CONTACT A.Fee for branch circuits with
��"'��� i above service or feeder fee, 7.42 2
Business name: }��,
each branch circuit
�`-'41;4 ' S L B.Fee for branch circuits without
Contact name: !1-G 0,---. \[a, e i.--, service or feeder fee,lint
56.18 2
branch circuit
Address: PO (307( 55 q,40 Each add'I branch circuit 7.42 2
City/State/ZIP: i 4 c 9 V7 o 2- Miscellaneous(service or feeder not included)
u 0. t l t� V Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Phone:( ) - (�99 , Fax: : } 3-7-2-7 Reconnect only _ 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: NorthStar Electrical Contractors Each additional inspection over allowable in any of the above
City/State/ZIP: 19450 SW Cipole Rd.,4107 Additional inspection(1 hr min) 66.25/hr
Tualatin,OR 97062 Investigation(I hr min) 66.25/hr
Phone:( ) (503)612-0840 Fax(503)612-0891 Industrial plant(1 hr min) 78.18/hr
Lit#34-359X CCB#90454 Metro#1911 1S 35 i0frFp�ions for which no fee is 90.00/hr
CCB Lie.: ,n yf — II+r t ,ic: specitically listed('h hr min)
ri. -. t +{�11,, J� i + ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal: ' Ir'5(j
Print name: J Plan review(25%of permit fee)_(fvt ° Date: /.--/ State surcharge(12%of permit fee): --7, t .
Authorized signature: TOTAL PERMIT FEE: i�i�� -4
•
st
Tbis permit application expires ifa permit Is not obtahltet Vithill
Print name: Date: days after it bas been accepted as complete.
* Number of inspections allowed per permit
I xu ildingPcrntitl.ELC_PeemitApp_SLI_EI£.doe Rev 05/2112013 440-4615111105/COa/WEa
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
❑ Garage Door Opener* 50.01 to 100 kva 552.26
•
>100 kva(fee in accordance with 552.26
n 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
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is
charged at an hourly(I hr min) 66.251 hr
Inspections for which no fee is 90,00/hr
specifically listed(%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 its permit is not obtained within 180
n Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
Boiler Controls
Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
Llnuilding\\PermitsEELC_PermitApp_ELR ERE.doc Rev OS/21/2013