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Permit CITY OF TIGARD ELECTRICAL PERMIT 11. COMMUNITY DEVELOPMENT • Permit#: ELC2014-00659 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 / /c) Date Issued: 11/18/2014 Parcel: 2S101AC01600 Jurisdiction: TIGARD Site address: 7150 SW HAMPTON ST 201 Project: EBS Associates Subdivision: BEVELAND NO.2 Lot: 18-19,P Project Description: TI for existing tenant. Tenant is expanding into space 201. 1/21/15,reprinted to revise permit scope of work, adding(1)100 amp sub panel and reducing the branch circuits to(7). Contractor: OWEN WEST ELECTRIC Owner: NEIMEYER,JOHN 8310 NW REED DR 15 82ND DR STE 210 PORTLAND, OR 97229 GLADSTONE, OR 97027 PHONE: 297-6375 PHONE: FAX: 503-297-6375 ( FEES Quantity Description Date Amount 1 ea Services or Feeders-200 11/18/2014 $100.70 Specifics: amps or less 7 crt Branch Circuits w/Purchase 11/18/2014 $51.94 Type of Use: COM Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 11/18/2014 $18.32 Electrical Type of Const: 8 Cash Over 11/18/2014 $8.31 Occupancy Grp: Total $179.27 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 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 copy of the rules or direct questions to OUNC by calling 503,232.1987 or 1.800.332.2344, Issued By: 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' 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. • . N TIGARD City of Tigard February 26, 2015 Owen West Electric Attn: Delano owen 8310 NW Reed Dr. Portland, OR 97229 Re: Permit No. ELC2014-00659 Dear Applicant: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 7150 SW Hampton St., 201 Project Name: EBS Associate Job No.: N/A Refund: ® Check#216595 in the amount of$8.31. ❑ Credit card"return" receipt in the amount of$ . ❑ Trust account"deposit" receipt in the amount of$ . Notes: Reduction in scope of work reduced permit fees. Refund difference. If you have any questions please contact me at 503.718.2430. Sincerely, Al ''''"-3 , Dianna Howse Building Division Services Coordinator Enc. 1\3125 S TiaEil 2 egon 97223 • 503.639.4171 I:\Building\Refunds A ni +pve ay. 6 07 elay: 50�3.684.277 • www.tigard-or.gov IrrCity of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts,documentation and the Reqiiestfbr Permit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Owen West Electric DATE: 2/19/2015 Attn: Delano Owen 8310 NW Reed Dr REQUESTED BY: Dianna Howse Portland, OR 97229 TRANSACTION INFORMATION: Receipt#: 198439 Case#: ELC2014-00659 Date: 11/18/2014 Address/Parcel: 7150 SW Hampton St.,201 Pay Method: Cash Project Name: EBS Associates EXPLANATION: Reduction in scope of work reduced permit fees. Refund difference. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example:Buildi i Permit Fee Example:. 2300000-43104 $Amount Cash over 100-0000-48001 I $8.31 1 1 TOTAL REFUND: $8.31 I APPROVALS: SIGNATURES DATE: If under$5,000 Professional Staff '�! °___-- If under$12,500 Division Manager If under$25,500 Department Manager If under $50,000 City Manager If over$50,000 Local Contract Review Board -- ' - FOR TIDEMARg SYST M ADMINISTRATION USE ONLY Case Refund Processed: J Date: _o2/o2d/�i F By: ...49(7/ I:\Building\Refunds\RefundRequest.doc x 09/01/2010 RECEIVEP Electrical Permit Applica on I Olt OI I It 1 1 `s1 I)\11 City of Tigard JAN 21 2015 Date/B Im® Permit#: E'-& ' 4140 óY 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review III • Phone: 503.718.2439 Fax: 5QJ f Date/B : Related Permit#: Inspection Line: 503.639.41751. FIG V�KV Ready Date/By: fur= 0 See Page 2 for I I Internet: www.tigard-or.govg NG 9IVlSIO Notified/Method: Supplemental Information OF WORK' PLAN REVIEW ❑New construction ddition/alte ion/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 0 Other: where the available fault current ❑Marinas and boatyards. CATEGO 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 `� ❑Addition of new motor load of system. ( Job#: Job site address: / 2 -t� cL.V 1 100HP or more. ❑"A",°E", '1-2 `°t-3' City/State/ZIP: S ❑Six or more residential units. occupancy. ❑ L�l-( f ❑Health raze facilities. Recreational vehicle parks. Suite/bldg./apt.#: Project name: ['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'1 500 sq.ft.or portion 33.92 1 DESCRIPTION F*WORK Limited energy,residential 75.00 2 (with nergey, lt) y . /`)tJ i U G� Limited energy,multi-family :�_ - ]L j j (1 L j pu `� /h c � ..-_. residential(with above sq.ft.) 75.00 2 '� /°ti`r�/ �"`-" C�� Renewable Energy ❑ See Page 2 ❑ PR PERTY OWNER 1:1 ANA �1 L Services or feeders installation,alteration,and/or relocation Name: e .44 tom� //h 63 100//I2/� a 200 amps or less J 100.70 2 Address: tp �/ et � 41 J 201 amps to 400 amps 133.56 2 / "�- � 401 amps to 600 amps 200.34 2 City/State/ZIP: dija!Lt.[, / i (7 ) , 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 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 ❑ APPLICANT 1 0 CONTACT PERSON Branch circuits—new,alteration,or ex_tension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, 7 each branch circuit 7.42 2 Contact name: B.Fee for branch circuits without service or feeder fee,first 56.18 2 Address: branch circuit City/State/ZIP: Each add'I 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: c/�U a- A/ L��K Sign or outline lighting 67.84 2- �3 (0 /� W ^ Sines,circuit(s)er n or limited-energy ❑ See Page 2 2 Address: ,(yam panel,alteration,or extension. g City/State/ZIP: �p,��p ,/ /J Each additional inspection over allowable in any of the above ty v't (/L-L _ ( e t V , 7 7 �"? Additional inspection(1 hr min) 66.25/hr Phone:(L5ely a Cj/ ....432,&-- Fax:(/ ) s' a_/n 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.:2._ 5f C Electrical Lic.:� _3/O — Suprv.Lic.:9_ c_C' specifically listed(V,hr min) 1 ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: (.l'/-f%!1� Subtotal: Print name: D c-L co 60 e lid Date: ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: � t�T0 I' 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_PennitApp_ELR_ERE.doe Rev 04/21/2014 440.4615T(I1/05/COM/WEB City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT q Request Permit Action TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division Services Supervisor 13125 SW Hall Blvd.,Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ❑ Owner El Applicant ❑ Contractor Z City Staff (check one) REFUND R Name: I E TO: (Business or Individual) .---Dg 1_4,,1 ti0 OLa)E 14„, - p ) C.e7 s i CAL EC/`,e i c_ Mailing Address: g 3 j O W-RNfc rb De.... City/State/Zip: —Po 2-rLA P.S ) O 2 97 a aq Phone No.: 503 - a-ci 7 - 1.0 -7 5- PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑ 4.11__. .__.VOID PERMIT APPLICATION. F� REFUND ' RMIT FEES (attach copy of original receipt and provide explanation below). MI INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). l REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: f e 01_0/47- O4 Co 5-? Site Address or Parcel#: 7/so S.e.J 1.14 i-f I''rb, ) . c:2C'l Project Name: EE S A-` ace__i ei-TF S Subdivision Name: Lot #: EXPLANATION: ion f• k- ! h t 1 f- ttDoQ_ au 5 JtJ 3 ' . _ . • O _,Signature: . Date: I/�//S' Print Name: ol5 A 1 i /1-0 4},y S1& Refund Policy 1. The city's Community Development Director or Building Official may authorize the refund of a) any fee which was erroneously paid or collected. b) not more than 80%of application fees when application is withdrawn/canceled before review effort has been expended or for issued permits, prior to any inspection requests. 2. The city's Engineer may authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 50%o of application fees when application is withdrawn/canceled before review effort has been expended or for issued permits, prior to any inspection requests. 3. All refunds will be returned to the original payer in the form of a check. Please allow 3-4 weeks for processing refund requests. Rte to S s Admin: Date B Rte to Records: Date_4271A111 B. t� Refund Processed: Date - .2e /.S By VPIA Invoice Processed: Date By Permit Canceled: Date ,J/9— By ki–V k'-V Parcel Tag Added: Date By Receipt# Date Method Amount$ I::\Building\Forms\RegPermitAction_082114.doc CITY OF TIGARD ' ELECTRICAL PERMIT a t COMMUNITY DEVELOPMENT Permit#: ELC2014-00659 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/18/2014 T[ ;ARP Parcel: 2S101AC01600 Jurisdiction: TIGARD Site address: 7150 SW HAMPTON ST 201 Project: EBS Associates Subdivision: BEVELAND NO.2 Lot: 18-19,P Project Description: TI for existing tenant. Tenant is expanding into space 201. 1(21/15,reprinted to revise permit scope of work, adding(1)100 amp sub panel and reducing the branch circuits to(7). Contractor: OWEN WEST ELECTRIC Owner: NEIMEYER, JOHN 8310 NW REED DR 1582ND DRSTE210 PORTLAND,OR 97229 GLADSTONE, OR 97027 PHONE: 297-6375 PHONE: FAX: 503-297-6375 FEES Quantity Description Date Amount 1 ea Services or Feeders-200 11/18/2014 $100.70 Specifics: amps or less 7 crt Branch Circuits w/Purchase 11/18/2014 $51.94 Type of Use: Service or Feeder Class of Work: 1 ea 12%State Surcharge- 11/18/2014 $18.32 Electrical Type of Const: 8 Cash Over 11/18/2014 $8.31 Occupancy Grp: 1 Total $179.27 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 accord 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. ATT ON: Oregon la, require ou to follow the rules adopted by the Oregon Utility • enter. Those rules are set forth in OAR 952-001 10 through 'AR 952-001-a r• • ma btain a copy of the rules or direct questions to OUNC •• 11E41 87 or 1.800.332.2344., / - Issu By: f/��f`/'rL Permittee Signa � 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—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 Total [ 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 50.01 to 100 kva 552.26 2 ❑ 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: El Other: Each additional inspection is 66.25/hr charged at an hourly(I hr min) Inspections for which no fee is 90.00/hr specifically listed(t/¢hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page I):y r Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems El Boiler Controls El Clock Systems ❑ Data Telecommunication Installation El Fire Alarm Installation ❑ HVAC ❑ Instrumentation El Intercom and Paging Systems ❑ Landscape Irrigation Control* El Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* El 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.doc Rev 04/21/2014 Electrical Permit Application FoR(H 1 1( 11 l til': O\1.1 City of Tigard Received Permit#: � • 13125 SW Hall Blvd.,Tigard,OR 97223 p Review ■ Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#: Inspection Line: 503.639.4175 Ready Date/By: Jurif: B See Page 2 for I I i \It I) Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK • PLAN REVIEW' ❑New construction Cl Addition/alteration/replacement Please check all that apply(submit I 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 ❑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 ❑Addition of new motor load of system. Job#: Job site address: IOOHP or more. ❑"A","E","t-2","I-3", Cl /State/ZIP: ❑Six or more residential units. occupancy. ty ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name: ❑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. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'1 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential (with above sq.ft.) 75.00 2 Limited energy,multi-family residential(with above sq.ft.) 75.00 2 ' Renewable Energy ❑ See Page 2 ❑ PROPERTY OWNER 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 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 ❑ 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 56.18 2 branch circuit City/State/ZIP: Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy CI See Page 2 2 Address: panel,alteration,or extension. g City/State/ZIP: Each additional inspection over allowable in any of the above 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('/z hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: ❑Plan Review Required(25%of permit fee):_ State surcharge(12%of permit fee): TOTAL PERMIT FEE: Authorized signature: _ 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. 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc 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 Fee for all residential systems combined: $75.00 Renewable I Qty. I Each 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 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 ❑ Garage Door Opener* >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 over 25 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 1 charged at an hourly(1 hr min) 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(Enter on Page 1): y ' Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation n Fire Alarm Installation ❑ 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.doe Rev 04/21/2014 CITY OF TIGARD ELECTRICAL PERMIT 311 _ - COMMUNITY DEVELOPMENT Permit#: ELC2014-00659 T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/18/2014 Parcel: 2S101AC01600 Jurisdiction: TIGARD Site address: 7150 SW HAMPTON ST 201 Project: EBS Associates Subdivision: BEVELAND NO.2 Lot: 18-19, P Project Description: TI for existing tenant. Tenant is expanding into space 201. Contractor: OWEN WEST ELECTRIC Owner: NEIMEYER,JOHN 8310 NW REED DR 15 82ND DR STE 210 PORTLAND, OR 97229 GLADSTONE, OR 97027 PHONE: 297-6375 PHONE: FAX: 503-297-6375 FEES Quantity Description Date Amount 15 crt Branch Circuits wo/Purchase 11/18/2014 $160.06 Specifics: Service or Feeder 1 ea 12%State Surcharge- 11/18/2014 $19.21 Type of Use: Electrical Class of Work: Type of Const: Occupancy Grp: Total $179.27 Required Items and Reports(Conditions) This per.. ' .-. b ect to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law. All work will be ••ne in accordance witlt,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 d. s. ATTENTION: Oregon law -q 'es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR • 2-001-0010 through OAR 952 6 1-0090. o may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19 r 1.800.332.234 ssued By: • � 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 -?) V ` / ()) AA. Date: `/ /9 LICENSE NO. O? 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 ApplicaIRECEI VEI) I ()1( (tl f I( I l �I. (t.I 1 Received etc�G}�C�-QQ�p S City of Tigard Date/B : �/ Permit No.: UPI 13125 SW Hall Blvd.,Tigard,OR "IV 1 $ 2014 Plan Review n APO/ �� Phone: 503.718.2439 Fax: 503.5':. 960 Date/By: Other Permit: I c, ;.l Inspection Line: 503.639.4175 , r V OF I Date Ready/By: turfs: ® See Page 2 for Internet: www.tigard-or.gov TV 1IVAKD Notified/Method: Supplemental Information DIVISION PLAN REVIEW • ❑New construction Addition/alteration/replacement Please check all that apply(submit a 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. CATEGO F 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 Commercial/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 system. larger separately derived system. ❑Addition of new motor load of ❑"A","E","1-2","1-3", •Job site address: J r 100HP or more. occupancy. Job#: �I / �� }erNt �M ❑Ni)(or more residential units. ❑Recreational vehicle parks. City/State/ZIt'- ❑Health-care facilities. 0 Supply voltage for more than V' ` ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.#: ./% r / Project name: ❑Service or feeder 600 amps or more. / IJ IrWag=wwramixaiw-_ FEE SCHEDULE Cross street/directions to job site: FAj A56ee, 4 Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot#: 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 r) 5-cf G,C_ I� .t O cl� residential(with above sq.ft.) y 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: each branch circuit B.Fee for branch circuits without I 1 Contact name: service or feeder fee,first 56.18 rcp,/!' 2 branch circuit Address: Each add'I branch circuit I 7.42 /o3.07 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"C, e/-J CL''Sy /.P G Signal circuit(s)eru or limited-energy See [ ( l panel,alteration,or extension. Page 2 2 Address: v 5 7,9 4.,....?1�J , IT-�c �[, Each additional inspection over allowable in any of the above _K'l Additional inspection(1 hr min) 66.25/hr City/State/ZIP:-n ^ ^ [� - Y�?l` ( C]1 L{ J- ( Investigation(1 hr min) 66.25/hr r Phone:(`jam I .t��' Fax:( ) ^ a Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCB Lie.: A$4�/'– Electrical Lic.:a' -3`g t'_. Suprv.Lic.: 9,Is 4 S S specifically listed(/z hr min) 90.00/hr ..3b4//.S.-- � �1/t/ /Of//ice ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: L-Q-r IA) "- Subtotal: /60'14 Print name: 'D e h l— C l�r�_ Date: / i lie__ilk Plan review(25%of permit fee): „ \ / ! v State surcharge(12%of permit fee): /?. �/ Authorized signature:O V '- (1)(AJ,ib--- TOTAL PERMIT FEE: /7?,iL 7 �D ' , 1 This permit application expires if a permit is not obtained within 180 Print name: 0 e- (---. C.X.A e Date)1 F ` f J-II days after it has been accepted as complete. • Number of inspections allowed per permit. I:\Building\Permits\ELC_PennitApp_ELR_ERE.doc Rev 04/21/2014 440-46157(11/05/CONt/WEB .9ct Ee e. 190 73610-4-k 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 Each 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 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 111 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 OAR 918-309-0040) ❑ Heating, Ventilation and Air Conditioning 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: 111 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(%a hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system $75.00 Subtotal: (SEE OAR 918-309-0000) * Number of inspections allowed per permit. Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation n Fire Alarm Installation ❑ 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.doc 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 7150 SW HAMPTON ST 201, TIGARD, OR, 97223 Commercial - Electrical 199 Electrical ﬁnal PASS - No C of O ELC2014-00659 Jeff Grove Violation Summary: Inspector Contractor