Permit CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT Permit#: ELC2014-00165
T W AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/17/2014
Parcel: 1 S135BD00300
Jurisdiction: TIGARD
Site address: 9735 SW SHADY LN 203
Project: Child Eye Care Association Subdivision: ASHBROOK FARM Lot: PTS 5&
Project Description: Electrical for TI.(17)branch circuits
Contractor: NIXON ELECTRIC CORP Owner: MCFADDEN,ARTHUR L
PO BOX 68569 BY SKLARZ, ERIC
PORTLAND,OR 97268 621 SW MORRISON ST, STE 800
PORTLAND,OR 97205
PHONE: 503-654-8841 PHONE:
FAX: 503-345-3403
FEES
Quantity Description Date Amount
17 crt Branch Circuits wo/Purchase 04/17/2014 $174.90
Specifics: Service or Feeder
1 ea Plan Review Electricial 04/17/2014 $43.73
Type of Use: COM 1 ea 12%State Surcharge- 04/17/2014 $20.99
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $239.62
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 acc with approved plans. This permit will expire if work is not started within 180 days of issuanc= or if work is suspended for more the 180
days. ATT ION: Oregon la, Jequires you to follow the rules adopted by the Oregon Utility Notification C= ter. Those rules re set forth in OAR
952-001- 10 through OAR 9• -001- 09 ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232. ,87 or 1.:1/1.332.2344
Issu d By: - • 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:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date: `�/7 //i
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 ...rrr 0 �, Permit No.: _ —� . _v� t
:� • 13125 SW Hall Blvd.,Tigard,OR 97223 �(
g Phone: 503.718.2439 Fax: 503.59 I Y Other Permit: / .'miaow:ma
i;t Inspection Line: 503.639.4175 E Date Ready/B . ' VI See Page 2 for
Internet: www.tigard-or.gov ** �� Notified/Method: �WMI �� Supplemental Information
TYPE OF WORK QQ. t °' r `r `iElP PLAN REVIEW
Please check all that apply(submit 2 sets of plans w/items checked below):
❑New construction Addition/alteration/replacemett RU
1�,� YIGA ERIMG ❑Service or feeder 400 amps or more ❑Building over three stories.
_❑ Demolition 0 Other: (;t -, �N� where the available fault current ❑Marinas and boatyards.
1" ,�j exceeds 10,000 amps at 150 volts or ❑Floating buildings.
CATEGORY OF CON�T��l� V
i less to ground,or exceeds 14,000 0 Commercial-use agricultural
El Com
1-and 2-family dwelling mercial/industrial ❑Accessory building lrr' 1 01 amps for all other installations. buildings.
❑Multi-family ❑ Master builder ❑Other: s4 ❑Fire 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.: 1 Job site address: Y 7 3 5' S 1. . S/(/A 0/y L/�NE 100HP or more. occupancy.
A ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: T(GA PD O/Q 9,-2-1 3 I ealth-care facilities. ❑Supply voltage for more than
0 Hazardous locations.
600 volts nominal.
Suite/bldg./apt.no.: I Project name:C///LO C y E CR I E ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: r/CARD M FDl CA L MALL 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
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER 0 TENANT r 20 amps to I 400 amps I 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
k Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
3 200 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 ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, 7 42 2
t
Business name: each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first I 56.18 r�, $ 2
branch circuit
Address: Each add'I branch circuit /6 7.42 l8, 3. 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
4
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: N I YoN E-L E-c• Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: PO Box 6$5C7 p p Each additional inspection over allowable in any of the above
City/State/ZIP: Po/7' ND i O/1 . / 2 6 8 Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
Phone:(503 )6Slt -$g'ii( Fax:(.5-03 ) 3 itS- 3 d 3 Industrial plant(1 hr min) 78.18/hr
�• Inspections for which no fee is
t CCB Lic.: /17508 Electrical Lic.: C 6S-5- Suprv.Lic.: 51$,5-13 specifically listed('/2 hr min) 90.00/hr
v ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: (y`t, `f c- 1
Plan review(25%of permit fee): it3.73
Print name: C R A(6_ R 0030(4 Date: t f/b7 tf State surcharge(12%of permit fee): 20, y
Authorized signature: TOTAL PERMIT FEE: Z 337 6 .1.
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.
L\Building\'ermits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-46151(11/05/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
9735 SW SHADY LN 203, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
May 22, 2014 at 9:51:19 AM
ELC2014-00165
Jeff Grove
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12244 SW GARDEN PL, TIGARD, OR, 97223
Commercial - Electricial Limited Energy
198 Low voltage final
PASS - No C of O
ELR2014-00165
Jeff Grove
Violation Summary:
Inspector Contractor