Permit 111 Y CITY OF TIGARD i>` IS / ELECTRICAL PERMIT
$ COMMUNITY DEVELOPMENT Often Permit#: ELC2014-00176
T t G RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/17/2014
Parcel: 1 S 135CA00600
Jurisdiction: Tigard
Site address: 11200 SW GREENBURG RD
Project: Autumn Oaks Apartments Subdivision: GREENBURG Lot: 11
Project Description: (6)branch circuits for attic fans.8/11/14,Reprinted to add(4)branch circuits. This work is in all six buildings.
Contractor: POLARIS ELECTRIC LLC Owner: AUTUMN OAKS PROPERTIES LLC
22380 NW SELLERS RD 9320 SW BARBUR BLVD#300
BANKS, OR 97106 PORTLAND,OR 97219
PHONE: 503-681-8013 PHONE:
FAX: 503-647-9099
FEES
Quantity Description Date Amount
1 ea Investigation Fee 08/11/2014 $90.00
Specifics:
10 crt Branch Circuits wo/Purchase 08/11/2014 $122.96
Service or Feeder
Type of Use: MF 1 ea 12%State Surcharge- 08/11/2014 $14.76
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $227.72
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. ATTENT . law r ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-00 through OAR 95 00 -0090. Yo may obtain a copy of the rules or direct questions to OUNC by callin 563Z3T 987 or 1.800.332.234+4.
Issued y: ! �� �' �`-� z Permittee Signatu eilt(
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' e7-7 r —`—J'" 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 R"xiB Ved
Date eillifillIfilgi/L
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 DateB : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Juris: RI See Page 2 for
I I'' \1`1) 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 2 sets of plans w/items checked):
❑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.
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
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 separately derived
//4.1a..:7- `` ❑Addition of new motor load of system.
Job#: Job site address: ,....)& —vc_ ,0 100HP or mare. ❑"A","E","1-2","1-3",
City/State/ZIP: El Six or more residential units. occupancy.
ty 0 Health care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Ave-,,,,_ ) ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: '
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
/'� �! � y (with above sq.ft.) 75.00 2
��`�`� ✓t —(� f�`( � Limited energy,multi-family
residential(with above sq.ft.)
75.00 2
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
❑ APPLICANT I ❑ CONTACT PERSON Branch circuits–new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first
branch circuit 56.18 2
City/State/ZIP: Each add'l branch circuit ! 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:-4 L' { — L,_ L L.0 - Signor outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. ❑ See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP:
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 66.25/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(V2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: t/ 1" Subtotal:
x1 Print name: y 7' f3 h/ ,a_ Date: c'/////[ ❑Plan Review Required(25%of permit fee):t e6JJ State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
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.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014 440-4615T(1I/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
Description I Qty. I Each I Total I .
Fee for all residential systems combined: $75.00 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
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
a 50.01 to 100 kva 552.26 2
❑ Garage Door Opener*
g p >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* 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 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(/z hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONLY:
Fee for each commercial system: $75.00 Subtotal(Enter Page 1):
y " Number of inspections alllowed owed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1.\Building\Permits\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014
CITY OF TIGARD ELECTRICAL PERMIT
ti s COMMUNITY DEVELOPMENT Permit#: ELC2014-00176
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/17/2014
Parcel: 1 S 135CA00600
Jurisdiction: Tigard
Site address: 11200 SW GREENBURG RD
Project: Autumn Oaks Apartments Subdivision: GREENBURG Lot: 11
Project Description: (6)branch circuits for attic fans.
Contractor: POLARIS ELECTRIC LLC Owner: AUTUMN OAKS PROPERTIES LLC
22380 NW SELLERS RD 9320 SW BARBUR BLVD#300
BANKS, OR 97106 PORTLAND, OR 97219
PHONE: 503-681-8013 PHONE:
FAX: 503-647-9099
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo/Purchase 04/17/2014 $93.28
Specifics: Service or Feeder
1 ea 12%State Surcharge- 04/17/2014 $11.19
Type of Use: MF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $104.47
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 co— eYalec direct questions to OUNC by calling 5 �
32.1987 or 1.800'+'+�a�
Issued _� _ - ermittee 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 � l (IIt III I I( I I sI (INI 1
City of Tigard CON-% `d , _
�fi Permit No.:
13125 SW Hall Blvd.,Tigard,OR 972 Plan Review
Phone: 503.718.2439 Fax: 503.598.1 + Date/By: Other Permit:
I I I;I i Inspection Line: 503.639.4175 rtV( Date Ready/By: lulls: El See Page 2 for
Internet: www.tigard-or.gov �� 11 Notified/Method: r� Supplemental Information
TYPE OF WORK �1Cj' OA PLAN REVIEW
❑New construction Ef ddition/alteration/i' �t 1v151 Please check all that apply(submit I sets of plans w/items checked below):
`` V ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: Y� where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTI ON 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 ❑CommerciaUindustrial ❑Accessory building amps for all other installations. buildings.
I I'ulti-family ❑Master builder ❑Other: ❑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.: Job site address: I f��J C SW 6Ice �v f� I Six or or more residential R occupancy.r
vv n ❑Six or more residrntial units. ❑Recreational vehicle parks.
City/State/ZIP: ..------ 2 ❑Health-care facilities. ❑Supply voltage for more than
rLya•
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: Avivna n U..k S ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 414.r+pne.t)13 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
w 1 6 L� r '7D- /1�f�` residential(with above sq.ft.)
—1)7,--
�((U// �j - !� p,,_-_,_ s-
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/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: p each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first
1 56.18 1. 2
branch circuit
Address: Each add'►branch circuit C 7.42 37r 10 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: Pc)'W f/ c 1c((if/tom LL G Signal circuit(s)or limited-energy See
`/ l panel,alteration,or extension. Page 2 2
Address: pet i) �/W s- l�S /C p1 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: , ,Jr..5• �R 9WD6 '
Investigation(1 hr min) 66.25/hr
Phone:(5V3) 6 k l 8-6/ 7 Fax:(S(/j> ) 6 cl 7- 1Q'71 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
90.00/hr
CCB Lic.: 1 q tee? Electrical Lic.: c�4 — Suprv.Lic.: . �4, specifically listed(Ys hr min) -
� � ELECTRICAL PERMIT FEES
Suprv.Electrician s g I e,required: ioaL ( !o t Subtotal: / 3 ,02 b-
Print name: ) f e_ r a C�// e Date: ./(.'7/201 y Plan review(25%of permit fee): Q
State surcharge(12%of permit fee): / /, j-
Authorized signature: TOTAL PERMIT FEE: C(' li , ( 7
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.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-46151(11/05/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 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
El 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
El Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
El 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
El Vacuum Systems* >100 kva—no additional charge 0.0 3
ElOther: 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(/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
ElAudio and Stereo Systems days after it has been accepted as complete.
Number of inspections allowed per permit.
El Boiler Controls
El Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
t:\Building'Permits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013
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
11200 SW GREENBURG RD, TIGARD, OR,
97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00176
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
11200 SW GREENBURG RD, TIGARD, OR,
97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00176
Jeff Grove
Violation Summary:
Inspector Contractor