Permit CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT Permit#: ELC2014-00143
Date Issued: 03/27/2014
T t t;A tz J) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S1356D01200
Jurisdiction: Tigard
Site address: 9800 SW SHADY LN
Project: Portland NCS Subdivision: MEADOW VIEW Lot: 8
Project Description: Electrical for TI:(8)branch circuits.
Contractor: PHOENIX ELECTRIC CO Owner: BURDICK-FORBES INVESTMENTS LLC
PO BOX 14037 BY DONALD C BURDICK
PORTLAND, OR 97293 434 RIDGEWAY RD
LAKE OSWEGO, OR 97034
PHONE: 503-231-8006 PHONE:
FAX: 503-235-4300
FEES
Quantity Description Date Amount
8 crt Branch Circuits wo/Purchase 03/27/2014 $108.12
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/27/2014 $12.97
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $121.09
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 --t forth in OAR
952-001-0010 through OAR 952-001-0090. You ma o• --.. the rul--or direct questions to OUNC by calling 503.232.1987(>4;000.332.2344. /
Issued By: - �— �� Permittee Signature: . /./ I�4.
OWNER INSTALLATION ONLY 1
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 i of of i It II 1 'NI. Ov I.)
Received •
City of Tigard Permit No: ��
IN • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit
I l�, 1,[� Inspection Line: 503.639.4175 Date Ready/By: �' ` ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: %/ l Supplemental Information
TYPE OF WORK ' ' ;1'-!. 1-'-'7'
E'-. 1-'.t PLAN REVIEW
❑New construction E 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 E Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fie 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" "1-2°"1-3°
Job no.:20 Job site address:9800 SW Shady Ln. IooHPor more. occ upancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:HCI-NCS ❑Service or feeder 600 amps or more.
J /���`� ��� 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'1500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 7500 2
Tenant inprovement of offices residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
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
❑ 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 I 56.18 56.18 2
branch circuit
Address: Each add'I branch circuit 7 7.42 51.94 2
City/State/ZIP: Miscellaneous(service or feeder not included)
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
CONTRACTOR Sign or outline lighting 67.84 2
Business name:Phoenix Electric Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address:PO Box 14037 Each additional inspection over allowable in any of the above
City/State/ZIP:Portland,OR 97293 Additional inspection(1 hr min) 66.25/hr
Investigation(I hr min) 66.25/hr
Phone:(503)231-8006 Fax:(503)235-4300 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 162753 Electrical Lic.: C89 Suprv.Lic.: 5169S specifically listed(vs hr min)
< DYi�C ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 108.12
Pr tt name: Terry Koch // Date: 3-26-2014 Plan review(25%of permit fee):
State surcharge(12%of permit fee): 12.97
Authorized signature: `f/ TOTAL PERMIT FEE: 121.09
r
This permit application expires it a permit is not obtained within 180
Print name: Terry Koch Date: 3-26-2014 days after it has been accepted as complete.
Number of inspections allowed per permit.
I\Building\Pennitsu LC_P■,mitApp_ELR_ERE.doe Rev 05/21/2013 440-4615T(I1i05/COM/WEB
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9800 SW SHADY LN, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
May 5, 2014 at 9:17:55 AM
ELC2014-00143
Jeff Grove
Violation Summary:
Inspector Contractor