Permit CITY OF TIGARD ELECTRICAL PERMIT
.1111 al
a COMMUNITY DEVELOPMENT Permit#: ELC2014-00076
Date Issued: 02/24/2014
T l G,A Ft t) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110DB01300
Jurisdiction: Tigard
Site address: 15298 SW ROYALTY PKWY
Project: EyeHealth Northwest Subdivision: 1996-010 PARTITION PLAT Lot: 2
Project Description: Electrical for TI:(27)branch circuits.
Contractor: KEC ELECTRIC INC Owner: TIGARD INVESTMENT PROPERTIES LLC
761 SW BAILEY AVE 11086 SE OAK ST
HILLSBORO,OR 97123 MILWAUKIE, OR 97222
PHONE: 503-439-0904 PHONE: 503 344-5100
FAX: 503-640-3838
FEES
Quantity Description Date Amount
27 crt Branch Circuits wo/Purchase 02/24/2014 $249.10
Specifics: Service or Feeder
1 ea 12%State Surcharge- 02/24/2014 $29.89
Type of Use: COM Electrical
Class of Work: ALT 1 ea Plan Review Electricial 02/24/2014 $62.28
Type of Const:
Occupancy Grp:
Total $341.27
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 issuan = or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adoated by the Oregon Utility Notification •-nter. Those rules set forth in OAR
952-001-0010 through OAR 952-001-0090. You may ob • es or di questions to OUNC by calling 50 ..r'.1987 or 1.800.332.2
Issued By: !/ rmittee Signature: ,�,. ■ 1ri "
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 01 41(i'�V I SE O\l.\
City of Tigard + l� : Permit No.: ^ _ _;. 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review +
Phone: 503.718.2439 Fax: 503.598. c•� DateB : -11, � Other Permit:
� \1J)
Inspection Line: 503.639.4175 + Date Re:`�lif v 1uris: ® See Page 2 for
I Internet: www.tigard-or.gov `O`it Notifi �+ :12../Ay It g?i 7 Supplemental Information
ak
OF WORK 1 . • �'"ErIke! L. LFs, PLAN REVIEW
❑New construction Addition/alteration/replace F -`�
Please check all that apply(submit sets of plans w/items checked below):
G\' G�ENG`N ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: IS.V1‘;''
the available fault current ❑Marinas and boatyards.
CATEGO F CONST i 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 ommercial/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 Addition system. larger separately derived system.
`_. ❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: Job sit address: A �, 100HP or more. occupancy.
f /5-- 1,S g (s-,) ky/,G,/i,,,�y ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: `-/— / 97— / Health-care facilities. ❑Supply voltage for more than
/ GGG- C ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: 1 Project name: <7 ' (r �(t� ❑Service or feeder 600 amps or more.
)a 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
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK • (with above sq.ft.) 75.00 2
Lc 7"(4 L /r.' 4 4 Limited energy,multi-family
ilgy ) 75.00 2
residential(with above s ft.
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
. 0 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/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) I 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, er panel
❑ APPLICANT I ❑ 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
. ,
branch circuit , 56-18 5 2
Address: Each add'I branch circuit � 7.42 19 L
City/State/ZIP: Miscellaneous(service or feeder not included) ,
Each manufactured or modular 67.84 2
Phone:( ) I Fax: :( )
dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
ONTRACTOR Sign or outline lighting 67.84 2
Business name: '/ Signal circuits)or limited energy See
(:) 71:**<,.. 7r��, / L panel,alteration or extension. Page 2 _ 2
Address: Each additional inspection over allowable in any of the above-
t' �� v` 3 p, r Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: t7/U 5 kro /,/'C?7/,, 3 �)-[ Investigation(I hr min) 66.25/hr
Phone:(TO) ) cfi 35 0c Dq I Fax:( Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: G`t c7 I Electrical Lic.' /_1/ C Suprv.Lic.:Lf F5' specifically listed(/,hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician sign' ��i', quired: 7' 7""$ '2 i I0 I Ito Subtotal: ¢_ite
t Plan review(25%of permit fee): �d 8
Print name: r0w�,� ( , y Date: a yi y//c.
( State surcharge(12%of permit fee): c',4,
Authorized signature: TOTAL PERMIT FEE: 3itL S:2
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\'ennits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013 440.4615T(l1/05/COM/WEB
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
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
1:1 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
❑ Heating, Ventilation and Air Conditioning OAR 918-309-0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over25 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(1 hr min) 66.25/hr 1
Inspections for which no fee is 90.00/hr
specifically listed(1/2 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.
" Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ O• utdoor Landscape Lighting*
❑ Protective Signaling
❑ O• ther
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013
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
15298 SW ROYALTY PKWY, TIGARD, OR, 97224
Commercial - Electrical
199 Electrical final
2014-04-16 00:00:00
ELC2014-00076
PASS - No C of O
Violation Summary:
Inspector Contractor