Permit CITY OF TIGARD ELECTRICAL PERMIT
III 3 ' COMMUNITY DEVELOPMENT Permit#: ELC2014-00621
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/29/2014
Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13500 SW PACIFIC HWY 30
Project: !chi Teriyaki Subdivision: FREWING'S ORCHARD TRACTS Lot: 15
Project Description: (1)sign lighting
Contractor: POLARIS ELECTRIC LLC Owner: ROIC OREGON LLC
22380 NW SELLERS RD 8905 TOWNE CENTRE DR, STE 108
BANKS,OR 97106 SAN DIEGO,CA 92122
PHONE: 503-681-8013 PHONE:
FAX: 503-647-9099
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 10/29/2014 $67.84
Specifics:
1 ea 12%State Surcharge- 10/29/2014 $8.14
Electrical
Type of Use: COM
Class of Work: NEW
Type of Const:
Occupancy Grp:
Total $75.98
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 i ordance wit--approved plans. This permit will expire if work is not started within 180 days of issuance, • if work is suspended for more the 180
days. ENTION. Oregon law,.requir- _you to follow the rules adopted by the Oregon Utility Notification C= er. Those rules are et forth in OAR
952-00 -0010 through OAR 952-001-,r:r. YoU'a obtain a copy of the rules or direct questions to OUNC by calling 503.232 987• 1.800.332.2344.
Iss ed By: /► - —A---� —�-ice Permittee 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' ' �� �t �� 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 Applicatio FOR OFFICE USE ONLY
City of Tigard DateByy, l0 / 1 Permit#: LC 1Qj -'O 2�
13125 SW Hall Blvd.,Tigard,OR 9BECEIVED
Plan Review j�
'' . ' Phone: 503.718.2439 Fax: 503.598.1960 0'T 2 9 pate/gy. Related Permit#: 6� / -QG^/7 l
Inspection Line: 503.639.4175 Ready Date/By: Sufis: HI See Page 2 for `
I I i,\I:1 1 Internet: www.tigard-or.gov CITY ol-1!/=01.11 ) Notified/Method: Supplemental Information
TYPE OF WWII i LEA l iIIQI ILf PLAN REVIEW
❑New construction addition/alterationirepNlaacement 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.
❑ I-and 2-family dwelling Et Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings. Z
❑Multi-family ❑Master builder ❑Other: ['Fire pump. ❑Installation of 150 KVA or k
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
/ ❑Addition of new motor load of system. N.
Job#: Job site address: /3 i o 0 Sw pa c-r(c t"10-/y I00HP or more. ❑"A","E "1-z°,"I-3", ,.`
City/State/ZIP: / �]2_2_. ❑Six or more residential units. occupancy. 1
ty �r tctl�d / o / / ❑Recreational vehicle parks.
❑Health Health-care facilities.
Suite/bldg./apt.#: 3 d Project name: Ter(y ZS ❑Hazardous locations. ❑Supply voltage for more than
t ( ❑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.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
(with above sq.ft.)
C ?e �t�'� Limited energy,multi-family
residential(with above sq.ft.) 75'00 2
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I El TENANT Services or feeders installation,alteration,and/or relocation
Name: P\j 11 C Lep 200 amps or less 100.70 2
2 r r ` 201 amps to 400 amps 133.56 2
Address: 1 7 f� 0 0 S�J Pal Cl f!G (�w -tdi 3 0
Y 401 amps to 600 amps 200.34 2
City/State/ZIP: ¶4 9,d I / D. ` q 7 2-0 601 amps to 1,000 amps 301.04 2
Phone:(19)) 5v — 1 0 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 1
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
fig APPLICANT I ® CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: The eeV1oe-vi Cirri f above service or feeder fee, 7 42 2
each branch circuit
Contact name: e r A e B.Fee for branch circuits without
service or feeder fee,first f(
Address: (B 648 $ W T(� WV branch circuit 56.18 2
City/State/ZIP: A l p h A 7 0 2 ` q'19 o 6 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(c03 ) z - o,9 3 Fax: :( ) Each manufactured or modular 67.84 2
Email: dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR / Pump or irrigation circle 67.84 2
Business name: fo p`c f 1 S E(CC'r! L , L Signor outline lighting / 67.84 (,7.541 2
ll�'1 Signal circuit(s)or limited-energy
Address: a� 8(/ My Se.//e/`5' panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: Cr 4 �- 0 JD 6 Each additional inspection over allowable in any of the above
Q���1/ �/ Additional inspection(1 hr min) 66.25/hr
Phone:(.3) 6g./ - U O I ? Fax:( ) Investigation(1 hr min) 66.25/hr
Email: d a la t-i(C K e `�V ,,,1,�f f. C ,,,t Industrial plant(1 hr min) 78.18/hr
��� Inspections for which no fee is 90.00/hr
CCB Lic.: / 10<3-3� Electrical Lie:: C63� Suprv.Lic.: 63/6 S specifically listed(%hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: f) a 7- 677.gt/
Print name: 04 f e_ T g L A k C.,_ Date: t`O/a -/0/y ❑Plan Review Required(25%of permit fee): -----l State surcharge(12%of permit fee): ?./V
Authorized signature:
TOTAL PERMIT FEE: 7 rj,qg
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 wermits1ELC_PermitApp_ELR_ERE.docx Rev 04/11/2014 440-4615T(II/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 z
5.01 to 15 kva 133.56 2
n 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
50.01 to 100 kva 552.26 2
n Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040) _
El Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
El *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 1
charged at an hourly(1 hr min)
Inspections for which no fee is
specifically listed(%z hr min) 90.00/hr
ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONLY: Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
I Fire Alarm Installation
H HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I\Building\Permits\ELC_PermitApp ELR ERE.docx Rev 04/21/2014
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
13500 SW PACIFIC HWY 30, TIGARD, OR,
97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00621
Jeff Grove
Violation Summary:
Inspector Contractor